Archive for January, 2010

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Oh for a Thimbleful of Gratitude!

January 29, 2010

By Christine Moffa, AJN clinical editor

I had surgery 12/28 and spent four days on med-surg afterwards. I literally spent 3/4 of my time sleeping (bliss! oh rapture unforseen!), but *every single time* anyone came into my room for any reason (meds, IV change, turn off the freaking IV alarm, phlebotomist, housekeeping, whatever), I said “thank you.” I got the feeling I was abnormal. . . . So. How often do your pts say thank you, and does it come as a surprise when they do?

It’s been a few years since I’ve worked directly with patients, but in the past when I had a particularly tough day I would tell people that “nursing is a thankless job.” I’m talking about the kind of day when you barely had time to use the bathroom, never mind eat something, and the only feedback you heard from patients and administration was about what you didn’t get done. So when I saw a post (excerpted above) called “How often do your pts thank you?” at Allnurses.com, it hit a nerve.

by Orin Zebest/via Flickr

The responses to the post were mixed, with some saying it’s common to be thanked by patients and others arguing the opposite. Maybe it’s regional—I’ve only worked on the East Coast, and in my experience complaints seem to get more air time than gratitude. Or maybe it’s just the times we’re living in. Either way, I’m sure most nurses would say they didn’t choose this career in the hope of being thanked all day long. I just think it could make the day a little more enjoyable if you were.

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Posted in nursing perspective, patient perspective | Tagged , , | 7 Comments »

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CDC Guidance for Relief Workers and Others Traveling to Haiti

January 28, 2010

This notice is to advise relief workers and other personnel traveling to Haiti to assist with the humanitarian response following the January 12th earthquake near Port-au-Prince. Conditions in the area remain hazardous, including extensive damage to buildings, roads, and other infrastructure.

The above is the start of a guidance document for relief workers heading to Haiti that is now available at the Centers for Disease Control and Prevention (CDC) Web site. It gives useful information on recommended vaccines; insect-borne and other infectious diseases; key items to bring; safety precautions related to accident risk, exposure to human remains, and animals; and psychological and emotional difficulties.

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Posted in international nursing | Tagged , , , , , , , | Leave a Comment »

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“As Comforting as a Rodeo Clown”: When Competence Is at Odds with Bedside Manner

January 28, 2010

Then it comes to me. This is the same recovery nurse who brought our son out of anesthesia when he had ear tube surgery. This is the woman who jostled him in her arms like she was mixing pancake batter in a Tupperware container, who insisted “baby need stimulus,” dancing away from me as Luke reached and screamed.

That’s from the Reflections essay in our February issue, and is written by a patient who tells a funny (and insightful) story of finding himself dependent for a second time on a nurse and doctor he’d sworn to himself he’d never let near him again. So, does it help to hear the patient perspective sometimes? (For the best reading experience, click through to the PDF version.)

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Posted in patient perspective, writing and nursing | Tagged , , | Leave a Comment »

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If Health Care Reform Were an ICU Patient . . .

January 27, 2010

The idea that the Health Care Reform bill is on life support is disappointing, but not surprising. It was admitted in a weakened state of health. It appears suspiciously a victim of domestic violence by special interest groups. The bruises on its body resemble the outline of handprints of the insurance companies it was created to protect our citizens from.

So writes nurse-artist-blogger JParadisi RN in a recent post, which (whatever your beliefs about whether we should do something major soon about the increasing numbers of uninsured Americans and the skyrocketing costs of health care) has particular resonance as President Obama prepares to address the nation tonight about this and other issues.


(Full disclosure: Paradisi’s artwork appeared on the October 2009 cover of AJN.)

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Posted in art and nursing, health care reform, nursing perspective | Tagged , , , | 2 Comments »

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Essential Reading for Nurses Responding to Disasters

January 26, 2010

Many nurses are volunteering their services to assist the residents of Haiti following the earthquake. The magnitude of the damages and injuries will require a sustained disaster relief effort. AJN has compiled a list of our articles with useful information for nurses participating in any disaster relief effort. Given the current urgency of this issue, we have made all articles free. We hope you’ll take a look and pass along anything you find informative or helpful.

For example, our Disaster Care article back in December dealt with the often-overlooked physiologic and psychosocial needs of children in public health emergencies. These can be very different from those of adults.

(And if, by some chance, you’ve actually had any experiences working in Florida or in Haiti with the victims of this earthquake, please let us know what skills and knowledge you’ve found most crucial.) 

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Posted in international nursing, nursing perspective, practice tips, professional identity | Tagged , , , , , | Leave a Comment »

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Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management

January 25, 2010

Shawn Kennedy, MA, RN, AJN interim editor-in-chief

RWJF reaction panel: Richard Hader, CNO, Meridian Health System, NJ; Mary Naylor, prof. of gerontology, UPenn.; Beverly Malone, National League for Nursing; Patricia Gerrity, 11th St. Health Center, Philadelphia; Susan Hassmiller, RWJF sr. advisor for nursing

Last week I attended a press conference in Washington, D.C., where the Robert Wood Johnson Foundation (RWJF) released a Gallup poll it had commissioned to find out what 1,500 opinion leaders (or as Gallup editor-in-chief Frank Newport put it, “the people who run things in this country”) think about nursing leadership and nurses’ influence on health care reform. 

It’s no surprise that most (69%) see nurses as having little influence on health reform. Nurses ranked at the very bottom—immediately below patients, who were below physicians in the rankings. Mary Naylor, an innovative leader from the University of Pennsylvania and part of a reaction panel, hit the nail on the head: “Everyone should be concerned that the largest group of health care providers and the consumers are the least influential.” (Those seen as having the greatest influence are government officials and insurance executives—no surprise there, either.)

In identifying what impedes nurses’ ability to be in leadership roles, here’s how the opinion leaders weighed-in:

  • 69.3% noted that nurses are not seen as important decision makers as compared with physicians.
  • 68% noted nurses were not seen as revenue generators like physicians.
  • 62.4% think nurses are focused on acute care and not prevention or health maintenance.
  • 55.8% think nurses lack a single voice in speaking on national issues.
  • 50.9% think nurses lack opportunities to move into leadership positions.

The good news is that the opinion leaders, for the most part, feel that nurses should have more influence in policy, planning, and management, especially around patient safety, improving quality, preventive care in the community, coordinating care, and “helping the system adapt to an aging population.” The top three suggestions, in answer to an open-ended question on what nurses need to do to gain more influence, were: nurses need to make their voices heard (15%), nurses need to have higher expectations and accountability (12%), and nurses needed to improve their image (10%). Read the rest of this entry ?

Posted in advocacy/political action, health care reform, media depictions of nursing, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 4 Comments »

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‘You Start to See Everything’: Jackie Robidoux, Nurse and Photographer

January 22, 2010

By Sylvia Foley, AJN senior editor

January 2010 cover: 'Two Does' by Jackie Robidoux

Jackie Robidoux, a staff nurse on the orthopedic unit at Elliot Hospital in Manchester, New Hampshire, is also an amateur tracker and an award-winning nature photographer. This month we feature her photographs both on our cover and in Art of Nursing.

“I love raw beauty,” Robidoux told AJN recently. To capture the image of the two does shown here, she waited for more than two hours on a hillside in 10-degree weather. “When you’re out there a long time like that, you start to see in a different way. You start to see everything around you.” Such patient alertness has also served her well as a nurse. To learn more, read On the Cover and visit her Web site.

If you’re a visual artist or a poet, we invite you to think about submitting to Art of Nursing. For details, read this blog post; guidelines can be found here. Still have questions? Write to me (I’m the department coordinator) and I’ll do my best to answer them: sylvia.foley@wolterskluwer.com.

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Posted in art and nursing, healing/holistic, nursing perspective, spirituality and nursing, writing and nursing | Tagged , , , , , | Leave a Comment »

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Praise for Haiti Nurse Volunteers–And a Word of Caution

January 21, 2010

Shawn Kennedy, MA, RN, interim editor-in-chief

International Rescue Committee Web site

As has happened many times before, nurses have stepped up to the plate in volunteering their services in the wake of the devastating Haitian earthquake. The California Nurses Association reported several days ago on its Web site that nearly 7,500 nurses had responded to a call by National Nurses United for volunteers. Nurses are also integral in the ranks of Médecins Sans Frontières , the International Rescue Committee, federal disaster response teams, and of course the American Red Cross.

What nurses should not do is take it upon themselves to fly to Haiti without being connected to an organized disaster group. Independent volunteers can create more problems and end up becoming consumers of disaster services instead of providers. As we noted in an AJN news article shortly after the September 11, 2001, attacks, “Because of the potential for injuries on site and subsequent health problems and stress syndromes, it’s essential that personnel location and hours spent at the scene be carefully monitored. Proper disaster management safeguards the lives of both victims and rescuers.”

Many first responders to the September 11 attacks subsequently developed respiratory problems; many suffered from depression. Many of these people had access to health care and counseling because they were monitored and registered and periodically assessed for postevent sequelae. But there were many “ad hoc” volunteers, who just showed up, without equipment, disaster training, or support. One wonders how many of these laudable volunteers suffered from subsequent PTSD.

Resource Compilation for Nurses Who Want to Help

So, if you feel driven to go to Haiti to help (as opposed to making a monetary donation), go with a bona fide group. (Nurses at the University of Maryland School of Nursing have a site listing organizations involved in the relief effort.) Make sure you have the skills and emotional makeup necessary to be of help. Here’s something from that 2001 news article that’s worth repeating: “Eileen Hanley, MBA, RN, is director of Supportive Care at Saint Vincent’s Medical Center in Manhattan, one of the hospitals that received many of the injured, including many rescue workers. She warns that when disaster ends, bereavement begins, and those planning disaster assistance must be sure to include mental health services for rescue workers and hospital workers as well as for victims.”

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Posted in advocacy/political action, international nursing | Tagged , , , , , , | 5 Comments »

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Smokers Need Not Apply

January 20, 2010
By Peggy McDaniel, BSN, RN

"Smoke break"/by sylvar, via Flickr

Are you a smoker? If so, and you live in Chattanooga, TN, don’t even bother to apply for a job at Memorial Hospital, where being a smoker automatically disqualifies you. To ensure that job applicants are telling the truth, the hospital will subject them to drug tests—for nicotine! This new rule does not apply to current employees, but it does raise some interesting questions. The article notes that such requirements for hire could be a slippery slope on the way to other forms of discrimination. 

As unpopular as this may be, as a fellow health care worker I can see a lot of positives to such a trend. In a previous blog post I discussed nurses as role models for our patients. My focus was on obesity,  but I also mentioned smoking.  

Another recent article, this one in the UK’s Nursing Times, says nursing students in Europe should be encouraged to stop smoking. The article discusses an Italian study reporting that nursing students are twice as likely to be smokers than are members of the general public. Maybe this would be a good policy to promote in the US? The article raises some of the same points I had raised in my earlier post about role modeling and the ways our actions or choices may influence our effectiveness as educators.

In addition to the health benefits in being a nonsmoker, there are also huge cost savings. As with obesity, smoking affects the overall cost of our health care system. The Tennessee health department told the press that an employee who smokes costs the hospital $2500–$4000 more in health care costs a year on average; according to another recent article, “smokers cost the country $96 billion a year in direct health care costs.” (By way of perspective, the article also points out that over time there is actually a societal cost benefit to smoking, since people who smoke die earlier. . . .) 

With the current focus on health care and insurance reform, Memorial’s new hiring policy may become more common around the country. What do you think? Is this good policy or outright discrimination?

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Posted in nursing perspective, nursing students, professional identity | Tagged , | 8 Comments »

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In Medicine as in Aviation, Communication Breakdown Leads to Fatal Errors

January 19, 2010

by dobrych, via Flickr

By Christine Moffa, MS, RN, AJN clinical editor

Lately I’ve had communication on my brain. I’m always amazed that we get anything done in this world at the rate that messages can get lost in translation. For instance, I recently had a phone call from a mother of two girls who was upset about a medication error involving her 12-year-old daughter. While the mother was at work, the child came home from school with cold symptoms and a temperature of 102.5. The daughter called her mother and was told to take two tablets of Sudafed, which she did. About an hour later, the babysitter picked up the younger child, age nine, from school. Concerned that her sister was sleeping unusually soundly, the nine-year-old called her mother at work. Realizing that just giving her older daughter Sudafed hadn’t addressed her fever, she told her younger daughter to wake up her sister and have her take “two Advils.” 

A few hours later the mother came home from work. As she was about to give her daughter another dose of medication before bedtime, she remarked to the children that she wished she had a combination drug containing both Sudafed and Advil so that the girl wouldn’t have to swallow four separate pills. The nin- year-old informed her that they did in fact have Advil Cold and Sinus; in fact, that was what she had given her older sister earlier when her mother told her to give her two Advils. The mother realized that her 12-year-old had ended up getting 120 mg of pseudoephedrine within one hour. Fortunately, her daughter was fine—before she called me, she had already called her doctor as well as poison control—but it did cause a scare for her family.

What went wrong?

  1. No adult was in the loop; at no point did the babysitter and mother speak about the plan for the child.
  2. The use of a brand name to refer to a drug instead of its generic name: the family had a bottle of generic ibuprofen in the house, but the mother used the word Advil.
  3. The person taking the medication was handed two pills without seeing the package that they came from.

It so happens that when I got the call I was reading a great book by Malcolm Gladwell called Outliers. According to the author, “A lot of the book is an attempt to describe the lives of successful people, but to tell their stories in a different way than we’re used to.” Read the rest of this entry ?

Posted in children's health, nursing perspective, practice tips | Tagged , , | 3 Comments »

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