Archive for the ‘Karen Roush’ Category


Don’t Write Off Community College to Start a Nursing Career

March 26, 2014

By Karen Roush, MSN, RN, FNP-C, AJN clinical managing editor

KarenRoushMy daughter is about to start her nursing career. She’s got all her prereqs out of the way and she’s waiting to hear from the half-dozen colleges she applied to. Among them is the community college where I started my career 35 years ago. That’s right—a community college that confers an associate degree.

I hope she gets in.

Community colleges are seen by many as the bottom of the ladder of desired schools of nursing. Not only do they offer only a two-year degree, but they’re not seen as being as selective as four-year colleges and they don’t have the big name professors.

But community colleges can and do produce great nurses. Programs are rigorous, so a more liberal admission standard at the onset doesn’t necessarily change the caliber of student who graduates at the end. And once they graduate, they must meet the same standards as students from four-year schools to attain licensure as an RN—everyone takes the same NCLEX. At the time of my graduation, my school had a 98% pass rate, one of the highest in the country.

Community colleges even have some advantages over a lot of four-year programs. They may not have the big names—but really, how many of those big name professors actually teach full courses? At community colleges, teaching is the focus. Community colleges are affordable; students don’t leave burdened with astronomical debt to start a career that, while setting them down firmly, and often permanently, in the middle class, can also saddle them with a burden of debt on top of all the expected financial struggles. And in many places, community colleges are truly embedded in their community; this can provide a level of support and open up opportunities for students that is not possible at larger detached universities.

I agree that all nurses should have a BSN, eventually. There is a lot of evidence that it improves patient outcomes. But the two-year community college can be a great place to start—two years of reasonably priced education that gives you a solid base of skills and knowledge to practice while you continue to take courses toward a bachelor degree. I remember when I returned to school for my bachelor’s: the wonderful sense of discovery that I was not just a nurse but a professional, and part of a profession with its own history and body of knowledge.

We need more nurses. All the experts agree that there is a shortage just waiting for the rest of the Baby Boomer nurses to hang up their stethoscopes. An education that starts at a community college can take a nurse far. I know mine has, from acute care staff nurse to long-term care educator, from oncology to urgent care to the IV team. Here in the U.S. and in India and Africa. As a nurse scholar at the WHO in Geneva, Switzerland, and as an NP in the Adirondacks of upstate New York.

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It’s Starting Again

September 25, 2013

Some Notes on Pink Ribbons and the Primacy of Breast Cancer Advocacy

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Breast cancer awareness giveaways/Wikipedia Commons

Breast cancer awareness cornucopia/Wikipedia Commons

It’s starting again. October is less than a week away and already they’re everywhere. But then again, they never really go away. Those darn pink ribbons.

Breast cancer is a terrible disease. My family has experienced its share and I know the anxious—it’s going to be fine, oh my god what will happen to my kids if I die—feeling of waiting for a path report after a lumpectomy.

But there are other terrible things that happen to women—and happen more frequently. And we don’t pay anywhere near the same attention to them. Take heart disease, for example. Heart disease is the number one killer of women. In 1999, according to the CDC, 24% of deaths in women were from heart disease, while 22% were from ALL types of cancer combined. Or consider domestic violence, experienced by one in four women during their lifetime while one in eight women will experience breast cancer.

So why is it that breast cancer garners so much of the public’s attention, and along with that, a disproportionate amount of its resources? It collects more funding than any other type of cancer. For example, lung cancer—according to a New York Times article, the National Cancer Institute spent $1,518 for each case of lung cancer in 2006 and $1,630 relative to each lung cancer death, compared to $2,525 per case of breast cancer and $13,452 per breast cancer death. Yet lung cancer is expected to kill 159,480 people in 2013, versus 39,620 deaths from breast cancer.

Breast cancer has got to be the most marketed disease ever. Every major brand has their pink-clad product, their pink ribbons and rubber bracelets. Now you can “support breast cancer awareness” with every action you take. From what you wear to what you eat, you can choose pink. You can meet all your hygiene needs while supporting breast cancer: soap, deodorant, make-up, shampoo, cologne, after-shave, manicure sets, and even teeth whiteners.

Why? I have a few ideas, shared by others. First, of course, is the financial incentive, which is worthy of a whole blog post itself. But I want to talk here of the cultural and social aspects. Read the rest of this entry ?


When Loved Ones and Patients Don’t Choose Life

July 15, 2013

By Karen Roush, AJN clinical managing editor

Photo by the author

Photo by the author

This isn’t the blog post I started out to write. That was a more personal story about someone close to me, let’s call this person Jess, who died after years of chronic illness worsened by self-neglect—after years of being that person Olsen talks about in this month’s article (free until August 15) on helping patients who don’t help themselves (and in his related blog post from last week).

But as I wrote, I realized that it wasn’t fair, that I was leaving out the complex story behind their persistent unhealthy behaviors, behaviors that eventually led to a lingering, awful death.

And without that background knowledge, it was too easy to be judgmental—as it is sometimes too easy for us as nurses to be judgmental of patients who don’t help themselves, who even seem to be willfully destroying their own health: the obese person who keeps drinking those giant sodas, the smoker who lights up another cigarette. As a nurse it can be very frustrating to care for a patient who ignores health recommendations, to their own detriment. As a family member or friend, it can be heartbreaking and infuriating.

There are limits to what we can do. We cannot force patients to eat well, take necessary medications, quit smoking, modify their alcohol intake, wear their seatbelts . . . the list goes on and on. Yes, we can and should provide patients with the tools they need to choose healthy behaviors: knowledge, access to treatment, realistic options, high quality, evidence-based care. We need to be persistent in our efforts and objective, and we need to show concern for their well-being. We also need to keep the politics—cost to society, impact on health insurance costs—outside the clinic or hospital door and outside the therapeutic relationship between nurse and patient.

Sometimes when I think about Jess I feel angry, but mostly I just feel terribly sad. Happy people choose health; they choose life. Jess chose neither. Why someone would do that is perhaps the most difficult thing for us, nurses or loved ones, to understand.
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The Hands of Strangers

April 16, 2013

By Karen Roush, AJN clinical managing editor

Boston MarathonA marathon is a triumph of spirit and endurance. It is a solitary endeavor carried along by a hundred thousand strangers. Anyone who has run a marathon knows that the spectators are not merely spectators. They are participants—they give their energy, their encouragement, their voices; they become part of your will, your perseverance; they carry you forward. Some part of every voice, every hand touched, crosses that finish line with you.

A marathon takes place in a particular city but it belongs to the world. For months, even years, someone in Sydney, in Kampala, in Seoul, in Cedar Rapids, in Damascus, in some small unknown village and in every great city, prepared for those same 26.2 miles ending yesterday at Boylston Street in Boston.

When I think about the marathons I’ve run, it is not crossing the finish line that I remember. What I took away, and what stays with me to this day, is a powerful and joyful sense of our shared humanity. That is what the bomber tried to shatter yesterday.

I have no doubt that in time investigators will find answers to who did this and why. But the greater questions will remain. How do we live with the certainty of our vulnerability? How do we come together freely and joyfully, knowing the threat that walks in our midst? How do we stay open enough to reach our hands out to strangers?

As we grieve the terrible losses suffered in Boston and face an uncertain future, we need to be like those participants lining the route, sharing our energy and voices to carry each other forward. We need to refuse to allow anyone to shatter our shared humanity.

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International Women’s Day: Remembering Lives Shadowed by Violence

March 8, 2013

Photo by Karen Roush

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

She lived in a trailer with her boyfriend and her three children, all under the age of five. He beat her up regularly.

Every few weeks she came in to see me at the health center where I worked as an NP in urgent care. Sometimes she would come in with bruises, but most of the time it was for the less obvious sequelae of violence—unexplained chest pain, palpitations, anxiety attacks, back pain, relentless headaches. There was a policy in urgent care that you couldn’t ask for a particular provider. So she would call to speak to me directly and when the operator put her through she’d know I was on and would come in.

I’m not sure why she came to trust me over the other providers. Maybe she could sense that I understood and didn’t judge her, though I had never told her about my own history of domestic violence. But it was probably because I listened. There was not much else I could do. She had gone to a counselor when I encouraged her to, but that didn’t last long—it was hard for her to find transportation for the 30-minute trip into town. I prescribed SSRIs, and after trying some different ones we found one that worked well for her. I helped her slowly cut back on the anti-anxiety medication she had relied on too heavily for so long.

It was all complicated by chronic neck and back pain. I got her in to see a neurologist, which eventually led to two surgeries that left her in more pain than before and with terrible sciatica. Still she came to me at each step for advice on what to do. The neurologist wants to do another MRI—should she do it? Now he wanted to do another surgical procedure—what did I think? And there was pain management thrown in on top of everything else.

Of course I knew that she wasn’t going to get better as long as she was with her boyfriend. We talked about that a lot. Read the rest of this entry ?


A Nurse and Mother on Dialing Back the Risk in Football

September 14, 2012

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

One Monday afternoon when my son Bryan was a senior in high school I got a call from him. He had hurt his back during football practice and was in so much pain he couldn’t move to get into his car. I rushed over to the field and found him standing, tense and still. When I lifted his shirt to look at his back, I gasped. The entire lumbar area was rounded and swollen out to the size of a grapefruit. At the hospital tests revealed he had a large hematoma, no critical damage done. The first question Bryan had for the doctor—“Can I play on Saturday?”

All week he insisted he could play and I insisted he couldn’t. His arguments never let up—he was quarterback and Saturday’s game was with an archrival. There wasn’t time for the backup quarterback to learn the plays, his team depended on him. Finally I made a bargain. We would go see his physician, whose judgment I trusted, and we would both respect his opinion, whichever way it went.

He played. One of the coaches wrapped his back in layers of padding with an ACE bandage and out he went. It was a brutal game. As determined as he was, the pain still slowed him down and he got tossed around like a rag doll. Finally in the last quarter they took him out.

I was reminded of all this when reading a New York Times editorial this week, “Dying to Play,” about the dangers of football and the growing body of evidence about the devastating long-term consequences of the repeated head trauma that football players endure. It talked about the decision a father, who was a pro football player, made with his son after his son got “his bell rung” in a game. They decided that the son, determined to follow his father into the pros someday, would “keep his mouth shut and his options open” rather than see the physician and wait for the okay to play.

Many parents will have their own version of these stories, the kid who insists on playing in spite of injuries or risk. They hide their injuries, downplay their pain, pop more ibuprofen than you know about. I watched Bryan’s best friend get knocked unconscious in a tackle, spectators standing silenced, watching, waiting for him to move as the coaches and the team doctor bent over him. Finally his legs started moving and people began to clap in relief and support, but I could tell by the erratic movement that he was actually seizing. An ambulance took him off to the hospital and next Saturday he was on the sidelines, impatiently waiting to get back in the game. Read the rest of this entry ?


Domestic Violence Screening: Why the Rush to Dismiss It?

August 24, 2012

Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

All rights reserved. Photos by author.

A recent study reported in JAMA, “The Effect of Screening for Partner Violence on Women’s Quality of Life” (abstract only), is being touted in overly simplistic headlines across the Web (the word “debunks” has been getting a lot of use) as further evidence that domestic violence screening doesn’t improve outcomes for women.

Don’t believe it.

The problem doesn’t lie with the researchers or with JAMA; they accurately reported just what they found. The problem lies with how it is being interpreted by others as further proof of the overall ineffectiveness of screening for intimate partner violence (IPV).

What the study actually found was that there was no difference in health outcomes between women who received computerized screening and a resource list and women who just received the resource list or women who received neither.

This is how it worked:

Women in primary care settings who agreed to participate and who were randomized to the screening group were seated in front of a computer and responded to the three questions in the partner violence screening (for example, “have you ever been hit, kicked, punched or otherwise hurt by someone within the past year?”) on the monitor. If they checked yes for any question, the computer played a short video of an IPV advocate who “provided support and information about the hospital-based IPV advocacy program and encouraged [them] to attend.”

All rights reserved.

So what’s wrong with this? True, this particular “screening” and “intervention” didn’t make a difference in the participants’ quality of life. The problem lies in the claims being made that this study proves that IPV screening doesn’t work. The reason this is a problem is not with the screening component. Research supports computer screening to improve disclosure rates—it’s one way to address the time burden that is often cited as a major barrier to screening, as well as the stigma attached to disclosure. So yes, further testing of this possible approach to screening is warranted.

The problem, as I see it, is with the approach taken with women who disclosed abuse. We know that women will disclose abuse and accept help if there is trust, the belief that you actually care about them, a nonjudgmental attitude and consideration for their safety. None of these things are present in this approach. In fact, it is the antithesis. What this approach tells women is that we cannot be bothered to actually talk to you in person—that would take more time, money, and actual empathy than we care to spend on you.

We also have evidence that a well-planned advocacy program with follow-up can work. This “intervention” doesn’t take into consideration the complexity of IPV. There are social, cultural, psychologic, economic, and physical factors involved. I don’t know what this computer-presented advocate says to the women watching. But even if it’s all the right things, she or he is still just an image on the screen.

And expecting women to take on all the emotional and practical challenges that disclosure and seeking help can entail, merely in response to a disembodied image on a screen, is a disservice to the women. Beyond the significant risk of increased violence and even death, there are so many other variables, such as fear of losing their children to protective services, or the difficulties involved in accessing resources when you are without transportation or funds. Read the rest of this entry ?


Women’s Health: Paying Attention to an Invisible Group

July 5, 2012

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

My sister Ellen is getting married in two weeks, so last Sunday I threw a surprise bridal shower. We had all the traditional trappings—flowers and favors and (much to another sister’s chagrin) a shower game and prizes. The only thing not traditional: at this shower there were two brides, my sister and her fiancée, Pat.

After years of standing by invisible while sisters and brothers married, danced with their partners at each other’s weddings, celebrated births and graduations, now it’s their turn. No longer on the periphery, no longer the ‘other,’ at least for this day, these few weeks, they are finally able to celebrate their love and commitment to each other just like the rest of us.

Why am I writing about this in a nursing blog? Because this invisibility, this sidelining of lesbians like my sister and her fiancée, doesn’t only affect their family life—it extends into their health care as well. Neither Ellen nor Pat ever got routine women’s health care—no Pap smears, no clinical breast exams or mammograms, no routine assessment for osteoporosis risk. They were never hooked into the health care system by reproductive health needs, contraception, or pregnancy and childbirth, as my other sisters and I were. They didn’t have a regular gynecologist who followed them through their reproductive years and would now advise them on preventive health care as they approached menopause.

This isn’t unusual among lesbians; according to the CDC, many avoid getting routine health care. And there is evidence that lesbians may be at greater risk for some health problems. For example, it is known that pregnancy and breastfeeding are protective against certain cancers such as ovarian and breast. Many lesbians never go through pregnancy and childbirth, yet they are less likely than other women to get routine Pap tests or mammograms. And they live with the constant stress of social stigma and discrimination, risk factors for depression, anxiety, and heart disease.

There are a number of reasons why lesbians don’t get necessary health care: lack of domestic partner benefits, which prevents them from qualifying for health insurance coverage through their partner’s plan; discomfort talking with their provider about their sexuality; being misinformed about their risks; and lack of knowledge on the part of their health care providers. According to the Institute of Medicine there is an urgent need for research—we know lesbians face unique problems and risks, but we don’t have an evidence-based understanding of exactly what they are or how to address them. Read the rest of this entry ?


To the Nursing Class of ’12 (and ’84, and ’96, and ’01)

June 15, 2012

By Karen Roush, MS, RN, FNP-C, clinical managing editor. A version of this essay originally appeared in the 2008 AJN Career Guide, but we feel it’s still just as relevant to new nursing grads or even to seasoned nurses (and non-nurses, for that matter) who might need a sense of renewal.

via Wikimedia Commons

On a rainy cold Saturday last May my son graduated from Rensselaer Polytechnic Institute in Troy, New York. As I sat shivering in my complimentary plastic poncho, listening to the commencement speaker doing his best to inspire the faces peering up from under soaked tassels, the thought came to me that we all need a commencement address every five years or so. Someone to tell us we can make the world a better place, that the possibility for greatness exists within us, that we may yet achieve our dreams. Someone to remind us why we chose nursing, and why we work so hard.

So, whether you are a new graduate or graduated 50 years ago, this is my commencement address to you.

Stay alert. Be vital. Sharpen your mind and your skills. Read journals for nurses and on health care in general. But don’t limit your knowledge to health-related information. Read political discourse, economic theory, and great literature. At the time of this writing, a book of poems, Slope of the Child Everlasting by Laurie Kutchins, sits on my desk at home. Each evening it pulls me into a deep reflection that informs my practice in a way clinical study alone can’t possibly do.

Keep moving. Learn, change, uncover, discover. There’s no other profession that allows you to do this like nursing. Whether it’s within your facility or as a travel nurse exploring the country, or perhaps going from clinical care to a policy-making position, movement will awaken the anticipation and excitement that you felt in the beginning of your career.

Look beyond your borders—whether they’re a shift, a hospital, a specialty, a state, a country. Reach outside of what you know. See yourself as part of something bigger than nursing. At the time of this writing, I’m about to leave for a trip to Uganda and Rwanda to see what it’s like to be a nurse in a place very different from home.

Act out. Be willing to anger people. Remember, you are valuable and necessary. Get your facts straight, then speak up loud and often. Make some noise and get some attention. And then be ready to back up your words with actions.

Become nursing’s biggest fan. Promote it. Boast about it. It will go a long way in making nursing what it should be—well paid, well understood, and respected. It will draw talented people to the profession. Nursing suffers from gender bias, this is important to recognize whichever gender you happen to be. It affects who goes into nursing, how your role is allowed to evolve, and how much you get paid. The answer isn’t in making the profession good enough for men; it’s in making the profession good enough.

Lastly, don’t let nursing define your whole being. Be a baker, a runner, a book club member, a father, a wife. Whatever it is, be it totally, ferociously, and separate from nursing. As a writer of poetry I am often referred to as a nurse-poet and I always protest. I am not a nurse-poet or a nurse-anything. I am a nurse and a poet . . . among other things. Nursing takes incredible mental and physical energy. Shelter that part of you that is away from nursing and it will energize your presence as a nurse.

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Staffing: Hot Topic as Usual for Nurses

May 31, 2012

Karen Roush, MS, RN, FNP-C, clinical managing editor

Our recent Facebook post on an article on nurse staffing at the NPR Shots blog (“Need a Nurse? You May Have to Wait”) got a lot of responses. Staffing is a hot topic for nurses—from both a personal  and a patient care perspective. And I say “hot” because it never fails to raise emotions.

Everyone agrees that adequate nurse staffing is essential for safe, high quality patient care and nursing job satisfaction. Research has shown that it significantly improves patient outcomes.

Yet we—nurses, as well as the larger health care community—continue to debate how to determine what “adequate staffing” is and how to best achieve it. Acuity-of-care measures? Unit-by-unit mandated staffing plans? State-mandated staffing ratios? What do you think?

We’ve published numerous articles and news pieces on this topic in recent years; here are a few examples:

News, reports, and analysis (open access articles)

“Nurse Staffing Matters—Again”

“California Mandated Nurse–Patient Ratios Deemed Successful”

“Nursing Shortage—or Not”

Feature. Requires subsciption or purchase; abstract only

“Nurse Staffing and Patient, Nurse, and Financial Outcomes”

And here are some blog posts that deal either directly or indirectly with issues related to nurse staffing.

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