Archive for April, 2011

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Superlatives: An Alternate List for Nurses Week

April 29, 2011

Photo from otisarchives4, via Flickr.

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

During Nurses Week (May 6–12), the hospital where I work gives out endearing little trophies as awards for “nursing superlatives.” Ballots are distributed with predetermined categories, and the categories are usually fun and relatively straightforward. They include: 

  • Best at Starting an IV
  • Most Likely to Crack a Raunchy Joke before Noon
  • Most Likely to Cry at Some Point during a Shift
  • Funniest Nurse
  • Most “Germ-a-Phobic” Nurse

The contests and catered meals, fun gifts, and light-hearted spirit of Nurses Week make it one of the nicest work weeks of the year, and we all come out of it feeling appreciated. But, in consideration of nursing superlatives, I’d like to propose some new categories. Although these titles won’t fit on the trophy plates, I think they’re worthy of recognition.

  • Most Likely to Notice, By the Tone of Another Nurse’s Voice, That Said Nurse Is Approaching a ‘Tilt’ Level of Stress, and Intervene Accordingly
  • Most Likely to Volunteer to Assist with Postmortem Care  (a job that nobody looks forward to, but that’s nonetheless important)
  • Most Likely to Accompanying Another Nurse on the Transport of an Unstable Patient to a Necessary Scan
  • Most Flexible; or Most Likely to Switch Shifts on Short Notice to Accommodate Another Nurse’s Unexpected Family Events

I’m often caught off guard by how perceptive my team is. The subtle interactions among us frequently surprise me, but they shouldn’t. We know each other’s strengths, weaknesses, and quirks very well. We make each other better and build each other up, and the security provided by that connectedness is priceless and vital.

I don’t mean to imply that we’re perfect. I’m not even sure we’re unique. But our engagements with each other make our team far stronger than the sum of its parts—and it shows in the care we provide.

This Nurses Week, if I were the one determining the categories, I’d award our team the title “The Most Amazing Nursing Team on the Planet.” A bit over-the-top, perhaps, but aptly so. In the spirit of nursing superlatives, I work with the smartest, most skilled, and kindest people in the world, and they’re worthy of the finest title I can imagine.

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Posted in nursing perspective | Tagged , , | 5 Comments »

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A Voice That People Will Hear: Tips on Getting Letters to the Editor Published

April 27, 2011

By Shawn Kennedy, AJN editor-in-chief

We get some interesting “letters to the editor” delivered to AJN’s editorial offices.

Many are what you might expect: letters disagreeing with an article or letters supporting an article, letters from retired nurses about how nursing has changed, and letters from students who write as part of a class assignment. Occasionally, we get letters worthy of framing, like a recent letter from a member of the U.S. Congress (we were delighted to find that members of Congress read AJN). We also get heartfelt letters from patients extolling the virtues of nurses who changed their lives.

The letters from nurses who support an article are in sharp contrast to those written out of disagreement. The supporters usually contain a poignant personal story or an argument based in professional experience or actual research, while the majority of those who don’t like something we’ve published are vehement and sometimes downright crude in their language.

We’re getting used to that, but we still wish it weren’t so, because we can’t publish those letters. (After receiving an especially vitriolic letter, former editor-in-chief Diana Mason wrote this editorial.) I received one the other day that began, “Those people . . . are laughable and pathetic.” And that was a mild one. Read the rest of this entry ?

Posted in nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , , , | 1 Comment »

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Swimming from Alcatraz

April 25, 2011

by jitze couperus via Flickr

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

I’m going to swim from Alcatraz.

It’s daunting, yet irresistible, and a challenge I’m not taking lightly. As part of my preparation, I’ve purchased the book Open Water Swimming: Lessons from Alcatraz. In it, Joe Oakes and Gary Emich deliver a wealth of information and practical advice in a very direct way. They’ve provided much to mull over during my long training swims—and I’ve been struck by how well the principles they stress can be applied to nursing:

“Never swim alone and always swim with a competent pilot.”

It would obviously be unwise to attempt a treacherous swim alone. Similarly, it’s vital to work with a team who can be trusted to back one another up. It’s also vital to know who the resource people are and to have a mentor, whether formally or informally.

“There are plenty of sharks in San Francisco Bay.”

Unfortunately, there are occasionally sharks amongst hospital staff, as well. Shark-like behavior should be identified for what it is, and handled accordingly. It should never be taken personally.

“Wet suits are the most obvious way to keep yourself insulated.”

The authors go on to discuss the relative merits of different types of wet suits, swim caps, booties, gloves, earplugs, and swim goggles. In the ICU, a decent stethoscope and good penlight are absolutely essential. Scrubs with good pocket placement are also important, as are comfortable shoes. Some of the other, almost limitless nursing gear available, like pen lanyards, badge holders, and stethoscope holders, are more arbitrary.

Regarding waves and choppy water, the authors advise, Read the rest of this entry ?

Posted in nursing perspective, professional identity, writing and nursing | Tagged , , , , | 6 Comments »

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Health Care Reform Works—If You Work It

April 22, 2011
Medical Bills

Image by urbanbohemian via Flickr

By Gail M. Pfeifer, MA, RN, AJN news director

My husband and I both recently had preventive screening colonoscopies, which are now covered under the Affordable Care Act (ACA) as preventive care for adults over 50. That coverage, if you purchased a new health insurance plan on or after September 23, 2010, which we did, means you do not have to pay a copayment or coinsurance or meet a deductible if you use an in-network provider (here’s a full list of preventive services covered under the new law). You would think that medical office billers and insurance companies would know that by now.

Although some plans have clauses that let them off the hook on this rule, ours does not—these tests should have been covered. Lucky for us, we knew it when the bills came in. To make a long story short, I was billed for the “surgery” and for the anesthesia. So I first called the billing department of the GI specialist’s office and asked them to rebill the procedure correctly, as preventive screening. No further bills from them, for me, but shortly afterward, my husband was billed by the same office for “surgery” occurring months later—same doc, same procedure, same billing office. He’s following up with phone calls as I write.

I next called the anesthesia billing office, which said our insurance company had denied the claim. I called the insurance company, which looked at our plan and found that, indeed, anesthesia should have been covered; they promised to issue a new claim number. Three weeks later, I got not one, but three, invoices from the anesthesia biller for the same deductible amount. I called them again, and they explained that, because “it takes 30 days for the new claim number to be received,” and “our system automatically sends” out invoices, I was mailed another bill (although they couldn’t explain the threesome). Seriously? Read the rest of this entry ?

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

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Open Your Mind: Brain Pickings and TED (NOT the compression stockings)

April 20, 2011

By Shawn Kennedy, AJN editor-in-chief

Twitter is a wonderful tool. This morning, as is my habit, I surfed my “favorites” column on my Tweetdeck platform to see what new and interesting things were being tweeted. And I noticed one of particular interest (I’ll get to it shortly) at the twitter page of Brain Pickings, a Web site that focuses on, in their own words,

“ . . . curating interestingness—picking culture’s collective brain for tidbits of stuff that inspires, revolutionizes, or simply makes us think. It’s about innovation and authenticity and all those other things that have become fluff phrases but don’t have to be.”

This twitter stream has alerted me to some unique and wonderful photographs, music, Web sites, charts and graphs, and books. True to its mission statement—and in service of the notion that “creativity is a combinational force”—it offers “[c]urated bits of culture that will, at the very least, introduce you to new ideas and perspectives and, at their very best, help you think more, laugh more, create more.”

click to go to Schulz TED talk

This morning, the tweet in question directed me to a video presentation by Kathryn Schulz, a self-proclaimed “wrongologist,” author of Being Wrong: Adventures in the Margin of Error. In it, she explains how we go through life trying to avoid being wrong (or, more correctly, being seen as being wrong), and how humans want to always feel “right.” She discusses how limiting that need to feel right can be for our view of the world and of others—especially those who disagree with us. She also gives an example of how it can be dangerous, as she points out in an example of a wrong-site surgery (the surgeon “felt” he was on the correct side”). Read the rest of this entry ?

Posted in professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | Leave a Comment »

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What’s Ugly? — And Other Crucial Conversations for Nurses

April 18, 2011

By Shawn Kennedy, AJN editor-in-chief

Metal billboard, Bubaque, Guinea-Bissau, 2010. Photo by Dawn Starin.

Our monthly Art of Nursing department—often, a poem or image somehow related to health care—is a unique feature for a scholarly publication, but one we feel strongly about. We believe that in order to provide truly holistic care, nurses need to know about more than evidence-based clinical content—they also need to be aware of many other aspects of the human experience. 

One thing art teaches us is that people don’t always see things the same way. What’s beautiful, illuminating, or at least useful to one person may be ugly or offensive to another. Consider billboards with public health messages. To some, such a billboard may seem to be an eyesore blotting the landscape; to others, the image and message is a powerful tool for disseminating life-saving information. Our September 2010 Art of Nursing (click through to the PDF version) showcased billboards in Guinea-Bissau, a poor country with HIV prevalence  of epidemic proportions. The billboards, photographed by Dawn Starin (here’s a blog post she wrote about them), are used to encourage people to get tested. A blog post by AJN senior editor Sylvia Foley about the column noted concerns some had expressed about these billboards:

Are the billboards effective? Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

On the other hand, here’s an excerpt from a recent comment by one reader of Sylvia’s blog post:

I think using public health billboards in Guinea-Bissau to combat the epidemic of HIV-AIDS is a great tool to reach out to the community and create awareness. Creative billboards do in fact attract people’s attention especially when it’s something as important as getting tested for HIV and AIDS. I can speak from personal experience as one day I was driving down a major highway in Miami, Florida and saw a very creative billboard about getting tested. The message on the billboard stuck with me for days until I decided to get tested. These billboards may not motivate everyone to get tested but I’m sure I wasn’t the only one that this billboard inspired to get tested.

We don’t know the results of this commenter’s test results—we can only hope they were negative. But the important point is that the billboard was effective: this person got tested. 

What are some other notable billboards promoting public health messages? If you’ve seen them, send us photos of the billboards (to Shawn dot Kennedy at WoltersKluwer dot com). We’ll post them online (and credit you!) and help spread the word.

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Posted in healing/holistic, HIV/AIDS, international nursing, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | 10 Comments »

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When Good Nurses Make Mistakes

April 15, 2011

The next day, as I prepared my medication tray with shaking hands, two physicians sat at the nurses’ station, talking too loudly as they discussed the medication error and wondered which nurse had made it. Overhearing them, I turned to confess, feeling like a marked woman. They muttered something in my direction, shook their heads, and quickly returned to their charting.

That’s an excerpt from fairly late in “Roger’s Angst,” the Reflections essay in the April issue of AJN. It explores the crippling shame, anxiety, and self-doubt that good nurses can feel when they make mistakes. And it suggests that no one, however conscientious they may be, is free from error in a long career—though few ever reveal their little secrets, even if we might all gain from the knowledge. A touchy subject, to say the least; we hope you’ll read the entire essay and consider weighing in with your own experience. Anonymous comments are, as always, fine.—JM, senior editor/blog editor

Posted in ethical issues, nursing perspective, patient safety, professional identity, writing and nursing | Tagged , , , | 4 Comments »

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Bearing Witness: April’s ‘Art of Nursing’ and Cover Art

April 14, 2011

By Sylvia Foley, AJN senior editor

In “Palm Sunday,” the poem featured in this month’s Art of Nursing, nurse and poet Rachel Betesh evokes the prolonged anguish of those who tend the dying. A man lies “sick and stained” in a bed, leaves his food untouched, and “hardly speaks anymore.” His wife and sons lament “the sin of the too-long moment”; time does not heal, but gapes like an “open wound between sickness and dying.”

A lesser poem might have slipped into sentimentality. But Betesh’s characters are a lively, indomitable bunch. “Pop!” the man’s sons say, visiting; you can feel their vigor. His wife remembers a baked potato he’d once given her, and her response: “You gonna marry me or what?” Indeed, it’s through witnessing, hearing the family’s stories, that the nurses can offer some comfort. They cannot heal the man, but they can “pack the wound, and listen.” (Art of Nursing is always free online—just click through to the PDF file.)

Windows and Doors by Paula Giovanini-Morris

This month’s cover art, a work of embroidery by nurse and fiber artist Paula Giovanini-Morris, explores the concept of memory and illustrates its mechanisms, the neurons and synapses through which the brain registers, encodes, and retrieves events. The piece, titled “Windows and Doors,” was prompted by another kind of witnessing: the artist’s visits to her mother, who was suffering from the early stages of dementia.

AJN senior editorial coordinator Alison Bulman spoke with Giovanini-Morris, who explained, “As I watched [my mother] search for words to express herself and attempt to recall recent events, I was struck by a sadness, realizing that in a short period of time the mother I knew might be replaced by someone who had no idea who I was.” Giovanini-Morris also acknowledged that she faces the possibility that she might eventually suffer from dementia herself. For more on this artist and her work, read this month’s On the Cover.

If you’re interested in submitting your own work to Art of Nursing—we consider visual art, very short “flash” fiction, and poetry—send me an email (sylvia.foley@wolterskluwer.com) for more information.

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Posted in art and nursing, home care nursing, nurses, nursing perspective, palliative care, patient perspective, writing and nursing | Tagged , , , , | 1 Comment »

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Same Boat, Different Ocean

April 12, 2011

By Shawn Kennedy, AJN editor-in-chief

Since the Robert Wood Johnson Foundation/Institute of Medicine Future of Nursing report was released six months ago, we’ve heard a lot about how nurses need to have more representation on boards of health care institutions and be more active participants in decisions about redesigning health care delivery systems. (See our online resource page for a variety of information about the report.)

To me, it’s a recommendation that’s so intuitive and simple that it’s almost embarrassing—and the need for it only drives home how absurd our health care system can be. It’s mind-boggling to me that organizations feel they can plan effective health care without the input of nurses. Imagine aircraft manufacturers designing a plane without input from the primary group—pilots—who will be responsible for flying it safely.

I suppose many health care entities and boards  feel that they have this input from physicians—but really, in most hospitals physicians aren’t involved in the nitty-gritty operations details that either make or break workflow processes or can impede the delivery of safe, cost-effective care.  How many times have hospitals planned patient care units or purchased equipment without nursing, input only to find that the systems aren’t workable or create more work? Read the rest of this entry ?

Posted in health care reform, international nursing, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 12 Comments »

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Nurses, Summits, and Salt Lake: The Challenges Facing New Nursing Grads

April 7, 2011

By Shawn Kennedy, AJN editor-in-chief

I’m attending the National Student Nurses’ Association (NSNA) annual convention, in Salt Lake City, Utah. I always gripe about meetings here—but then I arrive and realize I’d forgotten what a beautiful place it is. For one thing, there are the mountains rising up behind the cityscape—everywhere you look, there they are. (The photo here was taken from the plane as it was approaching Salt Lake City.)  There’s something really relaxing about these views.

I always enjoy this conference—I love meeting the future generation of nurses. This year’s group—about 2,400 strong—are enthusiastic, passionate, and serious about a career, not just a job. Many are people who’ve already been in the workforce. According to figures from the NSNA about the attendees, 47% are 26 or older, 22% are 36 or older, 52% will be graduating from baccalaureate programs, and 93% plan to continue their education. Impressive statistics.

Yesterday’s keynote speaker was Patrick Hickey, a professor at University of South Carolina–Columbia School of Nursing, who has summited the seven highest peaks in the world. He spoke about the challenges of his climbs, especially Mount Everest, where he spread the ashes of a friend who was supposed to have been with him. It was fitting—here, with mountains all around us, and with many in the audience facing their own uphill climb to find a job (for one new nurse’s advice on what not to say to a recent graduate in search of a job, read the April Viewpoint column in AJN, “I Answered the Call—Now Please Give Me a Job”).

Many of the students I spoke with who are graduating in May are finding it difficult to even get an interview. Read the rest of this entry ?

Posted in nursing students, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 7 Comments »

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