Archive for May, 2010

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Doing the Doctoring–A Nurse Who’s Filling the Primary Care Gap for Needy Children

May 27, 2010

By Peggy McDaniel, BSN, RN

A while back, a poll on the AJN Website asked if PhD-prepared nurses should be addressed as “doctor.” My answer was an emphatic “yes!” Janie, an old friend of mine, just graduated with her doctor of nursing practice (DNP) degree this past spring. She recently opened up her own clinic, serving kids as a primary health care provider in Portland, Oregon. She is the inspiration for my vote, but her chosen path isn’t easy.

Janie is filling a void in Portland that few providers are willing to address. She’s called Dr. Janie, and she well deserves the title. I have been a foster parent here in Oregon for the past few years. The kids that enter foster care often come from neglectful and/or abusive situations. These children can be hungry, fearful, wary, dirty, sad, and often confused and angry. They also deeply crave a sense of safety.

The state requires that these children be seen within 30 days of entering foster care. Getting them seen is a huge challenge. The requirement is, in theory, a great idea—these children often have multiple medical and psychosocial needs that have been neglected. But I couldn’t find a clinic in Portland that would take a “new patient” with welfare insurance within that time frame. It was often days or longer before I would find out basic information such as allergies about the children I was asked to care for. As a nurse, I found this lack of information to be unsettling, to say the least.

Janie has largely focused her practice on these children in need of prompt medical care. The article I linked to above points out the time and energy that Janie is willing to invest in these kids. I would argue that this style of “doctoring” is rarely seen in caregivers that do not have nursing as their base education. As the saying goes, “Once a nurse, always a nurse . . . ” From the reports of parents visiting Janie, this has never been more true.

There has been much discussion around nurses making a big difference in our health care system. Janie is a shining example of the new model of primary care—and a nurse on the front line. I’m sure there are many other nurses out there quietly answering the much debated question of how a nurse can be called a doctor.

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The Little Superstitions of Nurses

May 25, 2010

By Marcy Phipps, RN 

The first time I took care of a really sick patient in the ICU I was terrified. I didn’t fully trust my skills or instincts and often consulted with the experienced nurses around me. I was surprised when one long-time nurse suggested that tying a knot in a corner of the bed sheet would keep my patient from dying, at least during my shift. But I tried it. After all, what did I have to lose?

I was greatly relieved when my patient made it through the day. It seemed absurd that a knotted bed sheet could have any effect on life or death, but I didn’t entirely dismiss it—at least on some level.

The nurses I work with don’t discuss superstition any more openly than they discuss spirituality or religion. Most of us, however, have certain notions that we recognize and quietly adhere to.  Not a single one of us will say that it’s a “quiet day.” Nobody will pick up a Sunday paper on the way to work. No matter how difficult our assignment, very few of us will change assignments in the middle of consecutive shifts. Putting a chart together in anticipation of an admission is known to result in the admission being reassigned, and a code cart parked near an unstable patient is acknowledged to “ward off evil spirits.”

I would describe my fellow ICU nurses as scientists. We dislike ambiguity and are most comfortable in the presence of clear evidence, concrete numbers, and calculations. Even so, we hold onto our superstitions. Maybe we’re being silly, but perhaps we are acknowledging (or hoping) that there’s more to life than science.

Marcy Phipps is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN.

 

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What Lies Ahead? AACN Presidents Weigh In on Health Care Reform, Rapid Response Teams, and More

May 24, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Kristine Peterson & Beth Hammer, incoming and outgoing AACN presidents

On my last day at the American Association of Critical-Care Nurses’ annual meeting last week in Washington, DC, I had a chance to speak with both Beth Hammer, whose term as president ended with the meeting, and Kristine Peterson, the new president. Our conversation ranged from how they felt about being president of such a large nursing organization to their views on health care reform and how rapid response teams are affecting the work environment of critical care nurses. You can hear the conversation free on AJN’s Web site: go to the Podcasts tab and click on Conversations. Or just click here (the download may take a minute or two).

And don’t miss my first post from the exhibit hall floor at the meeting (the National Teaching Institute & Critical Care Exposition, or “the NTI”)  and my second post on a conversation with a critical care nurse about a bad staffing practice, which seems to have hit a nerve!

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Prospects for New Nurses: Thoughts on Graduating during a Downturn

May 21, 2010

By Christine Moffa, MS, RN, AJN clinical editor

Miami Beach & Port of Miami just after dawn / joiseyshowaa, via Flickr

Impending graduation is usually a happy, exciting time, especially for those who, after putting in years of hard work,  are finally about to get that college degree. In the mid-1990s I was in what I considered to be a pretty tough nursing program. For example, during my second semester of core classes we went from 30 students to 19; the drop-off was due to students failing out. Graduation couldn’t come fast enough.

However, when you find out that people who graduated one and two semesters before you are still looking for work, it can be a real buzz kill. That’s how it was for me in May 1995. During that time several hospitals were going through restructuring or reengineering (as this AJN article reported) and were replacing RNs with UAPs. It was next to impossible for a nurse without at least a year of recent experience to find a job in a hospital. Now, as a result of the recession, new graduates are  facing a similar situation. It took me almost a year to get my first job—and this was not without some sacrifices:  I had to relocate from New York to Miami and work the 12-hour night shift.

It ended up being worthwhile, but it was one of the hardest years of my life and potentially could have turned me off of nursing forever. Has anyone else out there had a similar experience? What advice would you give to nurses graduating this year?

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‘Go Home, Stay, Good Nurse’: Hospital Staffing Practices Suck the Life Out of Nurses

May 20, 2010

By Shawn Kennedy, AJN interim editor-in-chief

George is keeping an eye on you, by peasap / Paul Sapiano, via Flickr

After I last wrote to you from the NTI (the American Association of Critical-Care Nurses’ annual National Teaching Institute and Critical Care Exposition), I headed back to the exhibit hall to check out the helicopter and the Army’s mobile operating tent. But I didn’t get to either one, because I met a young critical care nurse from a regional hospital in Missouri. We chatted about her workplace, and it was obvious that she was very proud of the work she and her colleagues did. When I asked her, “What’s your biggest issue?”, she said that it was probably staffing. I expected her to cite the shortage and the difficulty of finding qualified critical care nurses. But that wasn’t what she meant—rather she was talking about  bare-bones staffing because of tight budgets. Her hospital routinely switches between two tactics: it sends nurses home when the patient census is low (when this happens, the nurses are paid only $2 an hour to be on call, but must still use a vacation day to retain full-time benefits, a tactic that rapidly depletes their vacation time); or, when the patient census is higher, the hospital imposes mandatory overtime, creating havoc in nurses’ schedules, finances, and personal lives. And people wonder why there’s a nursing shortage! Read the rest of this entry ?

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Thousands of Critical Care Nurses, a Helicopter, and More! AACN’s National Teaching Institute & Critical Care Exposition

May 19, 2010

By Shawn Kennedy, AJN interim editor-in-chief

 

NTI exhibit hall crowds.

I’m writing to you this morning from Washington, DC, where I’m attending the American Association of Critical-Care Nurses (AACN) 2010 National Teaching Institute & Critical Care Exposition (known simply as “the NTI”). I’m probably miscounting, but I think this might be my 15th visit to the NTI. I first attended when I was an ED staff nurse at Bellevue Hospital in New York City. I marveled at the hundreds of nurses who attended from all across the country. It was energizing and inspiring and overwhelming, and I learned a lot.

Now, it’s not just hundreds but thousands of nurses who attend the NTI, and they come not only from states across this country but also from around the globe. It’s still energizing, and there’s no doubt I can still learn a lot. Throngs of nurses have crowded the sessions, so much so that it’s hard to remember there’s a nursing shortage; but critical care nurses are still much in demand, and representatives from many hospitals—as well as from all branches of the military—are manning recruitment booths. The exhibit hall is still overwhelming: this year there are more than 500 exhibitors and the exhibits include a Life Flight helicopter, a couple of full-size buses equipped as classrooms or EDs, and a fully-equipped military emergency treatment tent.

I’ve attended some very good sessions and a couple of clunkers—a better ratio than I’ve found at most conferences. Now I’m off to interview the incoming and outgoing presidents of the AACN—look for that post, with a link to a podcast of the interview, in the next few days. I’ve got to get inside that helicopter . . .

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Who You Calling ‘Just a Nurse’?

May 17, 2010

It makes my blood boil when I hear a nurse say, “I’m just a nurse.” Sure, I’ve heard some nurses say, “I’m a nurse,” and I’ve heard many qualify their position by specifying, “I’m a critical care nurse” or “I’m a dialysis nurse.” But all too often, especially when asked whether they work in a specialty area, I hear nurses say apologetically, “No, I’m just a regular nurse,” or “I’m just a floor nurse.”

So says AJN‘s interim editor-in-chief Shawn Kennedy in her May editorial. Now here at AJN we’d like to reassure you that we don’t believe that anyone’s blood can actually boil. THAT is not an evidence-based statement. But Shawn’s hyperbole is meant to drive home a point: this is a topic that should matter to nurses, whatever their education level or exact job description.

We hope you’ll take a moment to read Shawn’s editorial in full and then let us know here what you think.

Longish sidebar: AJN may be a little uptight and old-fashioned about checking the facts we publish and making sure our editors and copyeditors fix unclear or inaccurate or simply awkward language, structure, and use of sources; ferret out conflicts of interest in our writers; and generally keep the journal a place you know you can trust in a world of shifting sources driven by suspect motivations. But here on our more informal blog, we also really really like (and do not edit!) reader comments, even very casual comments punched out on a tiny smartphone keypad.

Back to the main point: since Shawn’s editorial refers several times to articles and photos from the May issue, perhaps check that out too. A number of articles and departments—including the editorial, the CE features, the Viewpoint and Reflections essays, letters, and news—are always free.
—JM, blog editor

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Fetal Pigs and Popcorn: ‘Lessons’ in May’s ‘Art of Nursing’

May 14, 2010

By Sylvia Foley, AJN senior editor

Popcorn by twicepix / Martin Abegglen, via Flickr

To be frank, the opening scenario in Bernadette Geyer’s poem “Lessons,” featured in this month’s Art of Nursing department, made me uneasy when I first read it—and yet I was intrigued. In the poem, “Mom” has fallen asleep over a medical textbook, and her three daughters “watch as Dad / tosses popcorn, aimed for her slack mouth.” What’s going on here? The father’s action seems mocking, almost cruel.

But as good poems will, “Lessons” reveals more with each reading. The mother’s textbook is full of lurid photographs, including those of “a dissected fetal pig.” The young daughters find their own changing bodies “so embarrassing.” The father’s popcorn tossing makes his daughters giggle, and those garish photos of death recede just a little. Maybe that’s not a bad thing.  Read the poem—it’s free online (please click through to the PDF version)—and sit with it for a bit, see what you think. Then tell us in the comments!

Bernadette Geyer, a writer and freelance editor living in the Washington, DC, area,  received a 2010 Strauss Fellowship from the Arts Council of Fairfax County, Virginia.  Links to several of her poems can be found on her Web site.  She also blogs here about writing, motherhood, and life in “the exiles of suburbia.”

If you’re a poet or a visual artist, we hope you’ll consider submitting your work to us for consideration. Read this blog post for details. Guidelines can be found here. If you still have questions, feel free to write to the Art of Nursing coordinator (me) at sylvia.foley@wolterskluwer.com.

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Should Nurses Be Better Prepared to Meet Patients’ Spiritual Needs?

May 13, 2010

[A] survey of over 4,000 nurses found that only a small minority (5%) felt that they could always meet the spiritual needs of patients, and the vast majority (80%) felt that spirituality should be covered in nurse education as a core aspect of nursing.

The most important spiritual need identified by nurses was having respect for privacy, dignity and religious and cultural beliefs (94%). Spending time with patients giving support and reassurance especially in a time of need (90%) and showing kindness, concern and cheerfulness when giving care (83%) were also key concerns.

The above excerpt is from an article in Health News Today about a survey conducted among nurses in the UK. And here’s one more excerpt, a direct quote from a nurse who took part in the survey:

“I am a Christian. However, I do not believe it is appropriate for me to impose my beliefs on others while they are in a vulnerable position. What I do believe is that I support them in the particular spiritual needs during that time – whether they be Christian, Muslim, Atheist, whatever. It is their right to be treated as a whole, unique person and it is our duty, as nurses, to treat all our patients holistically, for the person they are and the beliefs that they hold. Physical care has to be tailored to each individual and so should spiritual care.”

But why bother? After all, who has time? Well, spirituality may affect outcomes. A 2004 article published in the Journal of Family Practice reviewed recent research (and also offered a number of practice recommendations).

Most people have a strong awareness of themselves as spiritual beings. For many, their spirituality profoundly impacts, and is impacted by, illness. A review of studies in which spiritual factors are included suggests spirituality influences the process of healing significantly, either positively or negatively.

Once intimately connected in Western medicine, argues the article, medicine and spirituality long ago took different paths:

With the advent of the scientific revolution and the emergence of the scientific method in the late 1500s, the relationship between spirituality and science changed dramatically. Since this new experimental method could not be readily or confidently applied to God, or to one’s experiences with God, religion/spirituality was excluded from the realm of science and a chasm emerged between the 2 realms.

by Lel4nd, via Flickr

What do you think? Murky waters? Do nurses have a role in providing “holistic spiritual care” for patients, whatever their own or their patients’ religion or lack thereof, or is this beyond the scope of the job? What’s your experience? -Jacob Molyneux, senior editor/blog editor

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New Nurse Keeps Grandma’s Gutsy Resolve, Varied Career in Sights

May 12, 2010

By Cara Gewolb, BSN. Cara lives in New York City and in January completed an accelerated 15-month BSN program at New York University College of Nursing for those with previous bachelor’s degrees. This longer-than-usual post was passed along to us by Barbara Glickstein, a producer and host of Healthstyles radio show, where Cara recently talked about her grandmother’s career as a public health nurse. We post it today in honor of Nurses’ Week—and also in honor of all the nurses who have recently graduated and are looking for work in a tight market.

My grandmother Frances Reichman Lubin had been the only nurse in her family until I received a BSN in January. As a new nurse I’m a bit unsure of myself, but I’m looking for work and excited to enter my profession. While I’m interested in becoming an ER or ICU nurse, my grandmother’s diverse career reminds me to stay open to opportunity. Her career extended from the 1940s to 1970s and encompassed stints as an army nurse, public health nurse, ICU nurse, teacher, and administrator, as well as time off to raise children and further her nursing education. I keep her example as a funny, gutsy woman who always kept her sense of purpose in my sights as I go forward. She died two years ago, after several years of dementia, but growing up I heard many stories from her and also from my grandfather.

No ‘calling’—just necessity. I was surprised and a little upset to learn that my Grandma Fran’s decision to become a nurse didn’t come from a deep “calling” within her. But her circumstances were very different from mine. She went into nursing to help support her brother Sidney through medical school. She grew up in Charlottesville, Virginia, during the Great Depression and her family was very poor, so she didn’t have the luxury of choosing what she wanted to do with her life.  Her family convinced her to pursue nursing because it was considered a low-paying, but stable, career.

Stuck stateside. Frances entered the U.S. Army after she received her RN degree in 1941 from Capitol City School of Nursing in Washington, D.C. She wanted to go overseas when the U.S. entered World War II, but due to a back injury she was stationed instead at Walter Reed Army Medical Center in Washington, D.C. Like all other nurses in the Army Nurse Corps, Frances was commissioned as a second lieutenant. She later rose to first lieutenant. My grandfather Samuel Lubin, her friend at the time and future husband, was required to salute her because he was a sergeant.

‘Tight regimen’ gives new hope for wounded soldiers. Grandma Fran’s most memorable time at Walter Reed took place when she was transferred to a unit for badly wounded soldiers, many with amputated limbs. She was appalled by the conditions on the floor and by the patients’ poor hygiene as well as habits such as nonstop poker playing and smoking. It seemed to her that the staff had given up on these men and that the men had given up on themselves. On her third day, she stood in front of the men and announced in her tough Southern voice that major changes were being instituted. She started the men on a rigorous regimen of bathing, grooming, and exercises.  She also ordered books to be sent from the hospital library and began a book club.

A few months later, the patients found out Nurse Reichman was being transferred to a different unit.  Read the rest of this entry ?

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