Archive for October, 2009
October 15, 2009
By Jacob Molyneux, blog editor/senior editor
The nursosphere is thriving and Change of Shift, the always interesting compendium of what’s new on nursing blogs, is up over at Emergiblog.
The health care reform process creeps slowly but surely toward an end someone somewhere can surely envision. One crucial question many are still asking is whether insurance companies might serve consumers a bit more readily and agreeably if they were forced to face a little competition from a public option. After all, isn’t competition supposed to be a good thing?
Most experts don’t expect the H1N1 vaccine to pose any more danger than the seasonal flu vaccine; even so, many Americans (and nurses commenting here, or taking our poll about the mandatory vaccine) continue to be wary, prompting public health officials to engage in especially aggressive surveillance measures in order to quickly detect any possible negative reactions to the vaccine: “Government Keeps Close Eye on Swine Flu Vaccine.”
AJN clinical editor Christine Moffa posted here a while back about how meditation might help cranky or exhausted or overworked nurses stay focused on what matters during the workday. Today the NY Times has a related piece on “doctor burnout” and meditation.
The role of social media in health care is constantly evolving as we all find our way. Its use by hospital workers is at issue in a recent post at Running a Hospital, about one hospital’s decision to ban social media from all its computers. And here’s something else on this: blogger Not Nurse Ratched wonders if social media policies in the workplace are going too far. How are Facebook, Twitter, etc., being used at your hospital?
Posted in ethical issues, H1N1 virus (swine flu), health care reform, media depictions of nursing, nursing perspective, writing and nursing | Tagged burnout, Facebook, flu vaccine, health care reform, healthcare, insurance, meditation, mindfulness, nurse bloggers, public option, social media, Twitter | 2 Comments »
October 14, 2009
In “Purgatory,” poet and ED nurse Stacy R. Nigliazzo writes about the sick and the stranded as they wait their turns at a hospital Emergency entrance—and the “nurse behind the bulletproof glass” who summons each in turn, her raw voice “calling sanctuary.” Read the poem here; listen to the poet’s reading here.
If this piques your curiosity, take a look at previous issues (Art of Nursing is always free; you might need to access page 2 or 3 of an issue’s table of contents to find it). To hear more poems read by their authors, click here. Interested in submitting your own work to Art of Nursing? Read this blog post for details. Guidelines can be found here; and if you still have questions, feel free to write to the Art of Nursing coordinator (me) at sylvia.foley@wolterskluwer.com.
Sylvia Foley, AJN senior editor
Posted in art and nursing, audio interviews, nursing perspective, writing and nursing | Tagged emergency nurse, emergency room, nurses, poetry, writing about nurses | Leave a Comment »
October 13, 2009
Update: Oct. 21: Thanks to everyone who took part in the vaccination poll (interestingly, only a fraction of those who visited the poll actually answered the simple yes/no question). The poll is now closed. The results: approximately 170 respondents (nurses?) answered the question “should the H1N1 vaccine be mandated for nurses?” Of these, 77% answered “no” and 23% answered “yes.”
Judging from comments we’ve received in response to other posts (here, here, and here) about the H1N1 vaccine, we surmise that not every nurse who answered no is actually opposed to getting the vaccine. They just don’t want to be told they have to get it. Others, of course (as some of the strongly worded comments left in response to this poll show) are entirely against it, whether it’s mandated or not. And others are wholeheartedly for it, firm believers that decisions made by experts using available evidence usually, if not always, lead to benefits for us all.
But there’s obviously a lot more to say on this topic, and we’ll be posting about it soon.
Posted in ethical issues, H1N1 virus (swine flu), legal issues, nursing perspective | Tagged mandated vaccinations, nurses, poll, swine flu vaccine, vaccination | 5 Comments »
October 12, 2009
By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
by obo-bobolina/via Flickr (Creative Commons)
The other day I saw a news report from Reuters noting that a study in the journal Science found that a retrovirus linked to prostate cancer may be implicated in chronic fatigue syndrome (CFS). The report explains that researchers “found the virus, known as XMRV, in the blood of 68 out of 101 chronic fatigue syndrome patients (67%). The same virus showed up in only 8 of 218 healthy people (3%).” The hopeful take-away message is that IF this virus does have a role in the development of CFS (and that’s still to be proven—all that can be said now is that this study found it to be predominant in people with CFS in comparison to those without CFS), then researchers can develop medications to treat this disease.
But what I took away was a different message. I remember when CFS was considered one of those nebulous, often self-diagnosed syndromes that led health care providers to attach some skepticism to whatever a patient who claimed to have one of them might say. There have been other diseases or clinical problems that have been dismissed by clinicians only to be verified later—fibromyalgia, restless legs syndrome, and “chemo brain” (the cognitive difficulties that often occur after chemotherapy; though a complaint of patients since the 1970s, it has only recently been verified by research) come to mind. There’s also another one, Morgellon’s Disease, the existence of which is now being researched by the CDC.
We’ve finally accepted the premise that pain is what the patient says it is. Why shouldn’t that extend to other complaints? Why is the burden of proof on the sufferer?
As clinicians in an evidence-based environment, we look for physiologic changes that can be screened, measured, palpated, auscultated, and monitored—we want to see or verify symptoms for ourselves. If you practice long enough, you’ll have at least one story about “that” patient who no one listened to—the one who, regrettably, someone should have listened to. Do you have a story to share?
Posted in nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged CFS, chemo brain, chronic fatigue syndrome, fibromyalgia, Morgellon's, prostate cancer, restless legs syndrome, retrovirus | 3 Comments »
October 9, 2009
It was a typical day in the ICU. I was wrestling with the numerous tasks I had yet to do, wondering how I would get them all done. I had three patients, I needed to draw blood gases and give my afternoon medications, and the charge nurse had just informed me that I needed to transfer one of the patients to the step-down unit-we were in a crunch for beds, and patients were waiting in the ED.
I still had a total bath and bed change to do, but the family members were in the room of the patient I needed to bathe. I had politely asked them to step out for a few minutes so I could finish my work. Now I gathered my supplies and went to the room, hoping they would take the hint.
I can’t remember her name, but I can still see her face and the fear in her eyes—and in the eyes of her family every time her cough triggered the alarm or she grimaced in obvious respiratory distress. She was on the ventilator—and much too young to be dying of breast cancer.
So begins the Reflections essay in the October issue of AJN. The essay is about how quickly roles can reverse themselves. It’s also about trying to strike a balance between efficiency and compassion; many nurses, we imagine, face some version of this challenge, if not so extreme, on a daily basis. Do you?
Posted in nursing perspective, nursing shortage, palliative care, writing and nursing | Tagged breast cancer, compassion, end of life care, end of shift, essay, ICU, nurses, terminal cancer, the art of being, writing about nurses | Leave a Comment »
October 8, 2009
Dietetics class for nurses, 1918/Cornell University Library/via Flickr
By Christine Moffa, MSN, RN, clinical editor
While I was going through nursing school I imagined that our clinical rotations would prepare us for the reality of working in a hospital. I was very eager to graduate and get my first job. Had I known that I was in for the hardest year of my life, I probably would have changed majors. I was hired to work the night shift in the float pool of a children’s hospital. That is a bad idea right there and I wish someone was there to talk me out of it. But on top of that, I found it difficult to express by opinion when residents and nurses with more experience did not heed my concerns about patients who were decompensating. And calling the attending in the middle of the night did not seem like a good option. I wish I had been told in nursing school that the nurse supervisor is a great resource to go to in times like these.
We often hear stories of what a shock it is for a nurse to finally start a nursing job after finishing school. Is there anything nursing schools could do to change this? Help us compile a list of things you wish you’d been taught in nursing school. If we get enough responses, we’ll publish the top five in the print and online versions of AJN.
Posted in nursing perspective, nursing students, practice tips | Tagged clinical rotation, curriculum, first job, new nurse, nurse, nursing school, student nurse | 9 Comments »
October 7, 2009
By Peggy McDaniel, BSN, RN
by futureshape/via Flickr
I recently read an article (“Time for ‘Dr. Next’?”) that focused on the differences between Baby Boomer physicians and Generation X physicians. The two groups apparently have a lot of angst about each other. While recognizing the younger doctors as collaborative and tech savvy, many older doctors express frustration with what they perceive to be less dedication to medicine. The younger physicians seek a healthier work–life balance, but the Baby Boomers remember putting in extremely long hours as students and also when starting their practices. Bringing these two groups together, often in the same practices, has highlighted their differences.
As it turns out, the same issues come between generations of nurses. This article from NurseWeek has some excellent advice and, although it’s from 2001, remains timely. It discusses different generational views about job security, technology, self-assertion, and other issues. One passage in particular jumped out at me:
Unlike many workaholic baby boomers who define themselves by what they do and how much they work, younger generations tend to see work as only a part of their lives. Generation X and Y nurses say the flexible hours and schedules of hospital nursing attracted them to the profession in the first place. To cope with the intensity of their jobs, they say, they need time to relax and pursue other interests.
If you’re a nurse manager and a member of the Baby Boomer generation, how do you deal with these younger generations of employees? Do you feel successful as a manager or are you frustrated? How about you Generation X or Y nurses? Are you being supervised by someone of an older—or younger—generation? Or are you supervising someone of another generation, and does that ever pose a challenge? Let us know what works and what doesn’t with staff from all age ranges.
Posted in nursing perspective, nursing students, professional identity | Tagged Baby Boomers, Gen X, Gen Y, generation gap, nurse management, nurses | 10 Comments »
October 6, 2009
By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
At the AJN Conference: left to right, Diana Mason, Amanda Stefancyk, Catherine Drous, Teresa Pavone
Speaking Sunday night at the first AJN Conference in Chicago, Diana Mason, AJN’s editor-in-chief emeritus, told the audience about her recent visit to the West Wing of the White House. If you watched the news that week you may have seen President Obama’s declaration to a crowd of nurses: “I love nurses.”
Mason told the conference that she was disappointed in the remark because “that’s not what nurses need.” Nurses need to be respected for what they know and for what they do, and then they need to be given a seat at the policy table when strategies for changing the health care system are being discussed.
Right now, she said, “no one is paying attention to the nurse-led models of care that work.” These include the American Academy of Nursing’s Raise the Voice Campaign; the AARP/Robert Wood Johnson Foundation Center to Champion Nursing in America; the Initiative on the Future of Nursing; and Transforming Care at the Bedside (TCAB), the collaborative initiative of the Robert Wood Johnson Foundation and the Institute of Healthcare Improvement. Read the rest of this entry ?
Posted in Diana Mason, editor-in-chief emeritus, health care reform, media depictions of nursing, nursing innovations, nursing perspective, professional identity, Uncategorized | Tagged Diana Mason, health care costs, health care reform, hospital quality, nurses, Obama, patient safety, quality improvement, quality of care, White House | 3 Comments »
October 5, 2009
Drug Administration through an EFT
By Sylvia Foley, AJN senior editor
Research indicates that a “surprising number of nurses” fail to follow guidelines for preparing and delivering drugs through an enteral feeding tube. (Do you find this surprising? Tell us in the comments!) This can result in medication error and tube obstruction, reduced drug effectiveness, and an increased risk of toxicity.
In this month’s CE feature Drug Administration Through an Enteral Feeding Tube, author Joseph I. Boullata describes the factors to consider before doing so and examines the gap between recommended and common practice. He also explains what the most recent guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend and why.
The ASPEN guidelines include:
- Do not add medication directly to an enteral feeding formula.
- Administer each medication separately though an appropriate access site.
- Liquid dosage forms should be used when available and if appropriate; only immediate-release solid dosage forms may be substituted.
- Dilute the solid or liquid medication as appropriate and administer using a clean oral syringe.
- Avoid mixing medications intended for administration through an EFT.
For the complete guidelines, check out Table 1 in the article. And for more on this and other aspects of enteral nutrition, visit ASPEN to read the full 2009 Enteral Nutrition Practice Recommendations. (ASPEN guidelines are free, but site registration is required.)
Posted in nursing research, practice tips | Tagged EFT, enteral feeding tube, guidelines, medication errors | 2 Comments »
October 2, 2009
Internet Splat Map (jurvetson/via Flickr)
Nurses, you’re being watched: a marketing Website has an article on the growing influence of nurses online. Let us know what you think. Here’s an excerpt:
. . . Manhattan Research recently released a report about nurses online noting that approximately three out of four U.S. nurses recommend health websites to patients. The study notes that the average nurse spends eight hours per week online for professional purposes, which is just as much time as physicians, and almost all of them use the Internet in between patient consultations. Nurses are also proactive in researching medical product information specifically online – over eighty percent have visited a pharma, biotech, or device company website in the past year.
In addition to the prevalence of the Internet as a research and patient communication tool, nurses are continuing to find their unique voices online through a growing number of prominent nursing blogs such as Codeblog and Emergiblog which both share powerful stories of healthcare from the nurses’ point of view.
Posted in children's health, H1N1 virus (swine flu), health care reform, writing and nursing | Tagged bloggers, flu pandemic, H1N1, health care costs, health care reform, healthcare coops, influenza vaccine, internet, marketing, nurse blogger, patient safety, pregnant women, roundup, swine flu, Tamiflu, Twitter, untapped market, vaccine safety | 1 Comment »
