Archive for March, 2011

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Vampire Nurses, PhDs, Your Best Moment as a Nurse: Today’s Notes from the Nursosphere

March 30, 2011

Here are some recent posts of interest we noticed on the nursing blogs. Many of these blogs can actually be found on our blogroll, so we hope you’re exploring what’s there from time to time, even if we know the list isn’t exhaustive and is probably missing some other excellent (and at least somewhat frequently updated) blogs.

It’s good to know that Will, the nurse/comic artist who shares his drawings at Drawing on Experience, has started posting again more regularly. One of his most recent efforts depicts a night shift nurse as a kind of vampire. It’s funny and, in a way, insightful. We give just a thumbnail version of it below on the right, in the interests of preserving the artist’s copyright; to see it enlarged, click the image and visit the version posted on his site, where you can also find a bunch more drawings, many about his life as a relatively new nurse. 

The INQRI Blog (that INQRI stands for Interdisciplinary Nursing Quality Research Initiative, a real mouthful) has a new post about an increase in enrollment in nursing doctorate programs. Here’s an excerpt:

According to new data released recently by the American Association of Colleges of Nursing (AACN), enrollment in doctoral nursing programs increased significantly in 2010. The AACN believes that this shows a strong interest in both research-focused and practice-focused doctorates.

The post also connects this enrollment trend with some recommendations from the IOM Future of Nursing Report, which we’ve written about more than once on this blog in recent months. But no more policy today! Whatever your degree, if you’re a nurse, you probably wonder from time to time why you do such a challenging job. An evocative post at Those Emergency Blues recounts an after-dinner conversation between two friends about just this. One of them asks the other, “What’s your best moment in nursing?” The author struggles to find an answer. Here’s part of what she says:

I stopped and thought. I could see my reflection in the dining room mirror, dimly, and even I could see bone-tired in my face. But I thought about codes and trauma. I thought about why I was once made Employee of the Month. I thought of smaller moments of giving care— warm blankets, a back rub, a cup of ice chips, repositioning. I thought about missed findings. I thought about the time a patient an ambulance gurney went VSA while I was triaging her, and walked out of hospital ten days later. I thought about innumerable STEMIs caught and thrombolysed (and later sent for rescue cathetherization) within minutes of arrival. I thought about the times when I pushed for some extra intervention which made a real difference in the patient’s life.

It’s engaging, but it’s probably not the most important part of her answer, which you’ll have to read the entire post to learn. Anyway, maybe we’ll steal the question and ask it here, since we’d really like to know what our readers think (as the chill air hangs on at the end of March and energy levels waver). So what’s your best moment as a nurse?—JM, senior editor/blog editor

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Posted in art and nursing, continuing education, nursing students, professional identity, writing and nursing | Tagged , , , , , , , | 2 Comments »

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Feeling Just Beachy

March 28, 2011

By Shawn Kennedy, AJN editor-in-chief

Last week I wrote a post here about the feeling of well-being—what it is, how it’s measured, and whether or not nurses often experience it. I guess writing the post struck a chord with me. I sometimes (often) feel overwhelmed with responsibilities at work and home and wish there was more time for fun, rejuvenating activities, and relaxing with friends. With this in mind, I decided to accept an invitation from friends to come for a visit.

My husband and I took a leisurely two-hour drive on Saturday down to see old friends at their new home on a New Jersey barrier island, one block from the ocean. Although it was a very cold day, the sun was shining in a bright, blue, cloudless sky. We decided to brave the wind and bundled up and headed out for a walk on the beach. 

The air had that salty-sun smell and the wind was blowing enough to make the water choppy and full of whitecaps—it was gorgeous and exhilarating, and we tramped about for an hour. Later, we headed out again, this time to wander around the point at the south end of the island, where migratory birds and turtle nests were protected. Nothing like an ocean wind to clear your head!

A good meal, some catch-up conversations and laughs—it was a fabulous day. At times, I could still hear that nagging part of my brain saying, “What about those e-mails you need to get out?” and “You have to write up that outline.” But I shut it out. 

Spending a beautiful day at a cold windy beach and connecting with good friends reminded me of what we all know but too often ignore: work will always be there, but you can’t get back the time you missed with special people. Carpe diem! (And if you’re waiting for a response from me, it might be a bit late . . . )

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Posted in healing/holistic, nursing perspective, Shawn Kennedy, AJN editor-in-chief, spirituality and nursing | Tagged , , , , , | 2 Comments »

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Are You a Well Being?

March 23, 2011

By Shawn Kennedy, AJN editor-in-chief

Flower Bowl, Spa / Badruddeen, via Flickr

A tweet from the UK’s Nursing Times recently caught my eye. It was directing Twitter followers to a post on its Web site, asking what “well-being” meant to them. The post discusses the work life vs. home life seesaw and whether readers’ chosen careers leave them time to enjoy other aspects of life. There’s actually a national well-being debate in the UK, where the Office for National Statistics is seeking public input in developing new measures of national well-being.

We measure well-being here in the U.S. too, with the CDC’s measures of health-related quality of life (HRQOL) index. While noting that “there is no consensus around a general definition of well-being,” the CDC sketches the concept of well-being in the following way:

“. . . at minimum, well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good. . . . physical well-being (e.g., feeling very healthy and full of energy) is also viewed as critical to overall well-being.”

Most people I know say they’re working harder than they ever did before. I see single parents and don’t know how they work full-time, deal with childrens’ schedules and needs, and make time for themselves. (I guess mostly they don’t—especially the part about making time for themselves.) I know many people who’ve taken on additional jobs—they teach but now also work per diem, or they work full-time in one setting and pick up weekend shifts elsewhere.

I’m sure patients feel the pressures, as we rush in and out of rooms, checking bar codes and IV pumps, and then whisking away to do it again in another room. Or what about in home health care, where visiting nurses don’t have time to “visit,” or even in psychiatry, which has morphed into a “get-em-in, get-em-out” assembly line. (See this recent post re. the demise of talk therapy.)  I hear from nurses who say that we’ve cut costs as much as we can—there’s no “doing more with less”; we’re doing less with less, and not doing it well. This discourages many nurses and can lead to burnout.

So I wonder: Do most nurses have a sense of well-being? Do you?

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Posted in healing/holistic, home care nursing, international nursing, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 13 Comments »

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Errors to Avoid in Scientific Publication, circa 1929

March 21, 2011

Shawn Kennedy, AJN editor-in-chief

Scholarly publication has been under fire because of lack of rigor and conflicts of interest. And authors seem to be clueless at times as to how things went so wrong.

Well, here’s some sage advice about common errors to avoid that I found in the July 1929 issue of AJN:

Posted in from the archives, nursing research, Shawn Kennedy, AJN editor-in-chief, writing and nursing | Tagged , , , , | Leave a Comment »

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You Mean You Want to Talk? A Patient’s Perspective on Speed Psychiatry

March 18, 2011

by prudencebrown121/via Flickr

By Amy M. Collins, associate editor

A recent post on our blog describing how many psychiatrists have abandoned psychotherapy in favor of short consultations and pharmacotherapy struck a chord with me.

Eleven years ago I moved abroad to live and work in a new country. I looked forward to great adventures, but I didn’t expect the sudden, crippling anxiety that spiraled into daily panic attacks lasting for hours. After several months I flew home to seek treatment.

I spent over half an hour in the waiting room wanting to crawl out of my too-tight skin. When he finally called me into his office, the psychiatrist smelled strongly of lunch and was still cramming a sandwich into his mouth—thus, I supposed, the long wait. I was still describing my symptoms when he shoved a checklist into my hands. I skimmed the symptoms—palpitations, trouble breathing, chest tightness, a need to escape—and realized I had them all. Bingo! His five-minute diagnosis: panic disorder.

I was overwhelmed with emotions: a mixture of relief to learn there was a reason for the mayhem, and something like a feeling of failure. When I started to explain the possible culprits (the move, the new language, the new culture), the doctor cut me off and handed me a prescription for Zoloft, explaining that antidepressants were also being used to treat anxiety, and that I’d probably feel worse before feeling better.

“I’m not sure I want to take medication. Can’t I just explain why I think this might be happening?” I asked. Read the rest of this entry ?

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

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Japan Earthquake Aftermath: What Nurses Need to Know About Radiation Exposure

March 16, 2011
Airborne radioactive material can have an effe...

Possible routes of radiation exposure. Image via Wikipedia

By Maureen Shawn Kennedy, editor-in-chief

The pictures are horrifying. First a 9.0 magnitude earthquake, then a tsunami, and now the Japanese people are perilously close to another disaster from radiation leaking from damaged nuclear power plants.

The death toll, already in the thousands, possibly tens of thousands, will undoubtedly climb without the intervention from disaster relief organizations, which may be reluctant to send their responders into areas with high radiation. After its ships and crew were exposed to radiation from a leaking reactor (the New York Times reported that the deck crew on the U.S.S. Ronald Reagan was exposed to radiation that “caused them to receive a month’s worth of radiation in about an hour”), the U.S. Navy repositioned its ships further off the coast of Japan as a precaution, and is conducting relief operations from the north, away from the wind currents.

There’s been much discussion in the media about the effects of radiation, what levels are harmful, etc, and nurses may indeed receive questions from patients or families with members participating in relief efforts. Here are two articles from AJN that will help you answer questions (they’ll be free until April 18):

Here’s an excerpt from the first of these two articles:

PATIENT DECONTAMINATION
• Remove the patient’s clothing and dress him in
scrubs or a gown.
• Rinse contaminated areas of his body with saline
solution or deionized water.
• Shower or bathe him, using mild soap and
cool-to-warm water.
• After the bath, discard the sponge or washcloth
according to radioactive-waste disposal methods.
(The water should be saved in a drum or carboy;
clothing, sponges, and washcloths should be disposed
of in a radioactive-waste can.)
• Flush open wounds with saline solution or deionized
water.
• Use standard sterile practices when administering
injections, suturing, or other procedures that puncture
or break the skin.

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Posted in international nursing, nursing perspective, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , , , , | 3 Comments »

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Six Degrees of Separation: How Close Is Too Close?

March 15, 2011

By Julianna Paradisi, RN, OCN

1st practical transfusion method/otis archives3, via flickr

I stand in the fluorescent-lit hallway, waiting my turn at the window to pick up two units of blood from the blood bank. Ahead of me, a woman whose hair is swallowed up by a paper bouffant cap wears blue scrubs and hot pink Crocs on her feet. I assume she’s from OR, because of her garb. The blood bank is located in a staff only access area, and the hallway is narrow. Loitering, I feel the same awkwardness I feel standing on a sidewalk while waiting my turn at an ATM. What’s the socially acceptable separation between the person I’m waiting behind and myself? Too much, I block the hallway or the sidewalk for others. Not enough space, and I intrude on the interaction. How close is too close?

On my way back to the clinic, I carry the units of blood in a Playmate cooler marked “Biohazard.” I stand in another hallway waiting for an elevator. It’s flu season, so I hit the “up” button with my elbow to avoid getting virus on my hands. I look around first so visitors won’t see me do it. I don’t care if hospital staff watches. They understand. The elevator door opens, and I get in. After the doors close, the person standing next to me coughs as if expectorating a lung. This is too close.

Back in the clinic, I double-check the first unit of blood with another nurse. I am about to put the blood of a human being into the veins of another. If the match is wrong, it is not close enough, and the blood will harm its recipient. Too close is an abstraction, a meaningless idea in blood transfusion.

I remember placing my hand deep into the chest of a patient once, so close I could feel the heart beating against it. “This is life,” I thought to myself, “and I am as close as can be.”

Julianna Paradisi blogs at JParadisi RN; her artwork appeared on the cover of the October 2009 issue of AJN, and her essay, “The Wisdom of Nursery Rhymes,” was published in the February issue.

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Posted in nursing perspective, writing and nursing | Tagged , , , , | 1 Comment »

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A Nursing Report That Deserves More Than The Usual Shrug

March 14, 2011

By Christine Moffa, MS, RN, AJN clinical editor

The IOM report The Future of Nursing: Leading Change, Advancing Health came out this past October, causing a flurry of excitement among some in the nursing world and groans of “big deal” among others. My immediate instinct was to shrug my shoulders and wonder if yet another report will really make a difference at the bedside.

AJN addressed the report and its implications in our December 2010 and February 2011 issues—so I knew it must be very important. But, for some reason, I had assumed it was going to be a dry, unreadable bore. And I put off reading it until recently, when I needed to use it as a reference. And wow, was I in for a surprise! I especially liked the inclusion of real case studies of nurses from different backgrounds and work experience who are making a difference in health care.

It’s inspirational, and I encourage all nurses out there—and anyone with a stake in health care (that’s pretty much everybody)—to take a look. (Tip: I found downloading the PDF version didn’t take long, and it was much easier to navigate than the HTML version.) If you’d like to hear more on the report and what it means to nurses, sign up for our upcoming Webcast about it. Let us know if you have any questions or comments, and we can try to address them in the discussion. Here’s the official promo info:

LWW Nurse Editors’ Roundtable – The Future of Nursing
Tuesday, March 22, 2011, at 12:00 pm EDT / 9:00 am PDT Read the rest of this entry ?

Posted in advocacy/political action, media depictions of nursing, nursing perspective, nursing research, professional identity | Tagged , , | 5 Comments »

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Laundry

March 10, 2011

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

An eager third-year BSN student was assigned to me yesterday. After introducing herself, she told me quite enthusiastically that she’d already decided she wanted to work in a trauma ICU after she graduated.

I love that. I remember feeling just as wide-eyed and excited as she looked. And I like having students with me, especially ones who are so teachable that they soak up everything around them like a giant sponge.

My student’s willingness to do “everything” served her well, as far as learning experiences go, and she approached tasks without trepidation. She was elated with success (insertion of a nasogastric tube) and mortified with failure (insertion of a rectal tube; she actually vomited). There were moments of fascination (touring the ICU and helping settle in a trauma admission) and boredom (attending a pain management process improvement meeting).

There was also frustration; at the end of the day, she ruined her new scrub top with a spill of dark orange rifaximin.

by adria richards/via Flickr

I’m not sure what her favorite part of the day was (although I’ll bet it was her nasogastric tube success), but my favorite part of her day was overhearing a member of the SWAT team, who was armed and stationed at the bedside of a nearby patient, tell her, in all seriousness, that Dreft laundry detergent would be her “best bet” at getting the medication stains out of her scrubs.

Now, I suppose that SWAT team members, like nurses, have a lot of first-hand experience in getting unusual stains out of work attire, but I must admit I’ve never given the matter much thought. I don’t think of tough guys doing laundry. I never imagine tough guys in the detergent aisle, shopping for Dreft.

I didn’t get to ask my student if she still wanted to work in the ICU, as she was running late for her post-conference, but I’ll bet she still does.

It’s not always pretty, but I can’t imagine someone not wanting to work in a place where rectal tubes and SWAT team laundry advice are punctuations in an otherwise ordinary day.

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Posted in nursing students, professional identity, writing and nursing | Tagged , , , , , , , | 7 Comments »

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On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

March 8, 2011
President Barack Obama speaks to a joint sessi...

Obama Speaks to Congress on Health Care/Image via Wikipedia

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful [health] system on the planet. Its fiscal future would be transformed if Congress passed reforms that emphasized control of costs as much as the expansion of coverage that Barack Obama rightly wants.”

Why should any of this matter to nurses? Here’s a post reminding us why nurses have a stake in health care reform. 

But back to nursing proper, nursing in the trenches, nursing not in the abstract but in its inescapable dailiness. Read the rest of this entry ?

Posted in Uncategorized | Tagged , , , , , | 1 Comment »

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