Archive for the ‘nursing perspective’ Category

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What Advice Would You Give a New Nursing Student? Our Readers Respond…

April 9, 2014

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

My daughter Kim is starting nursing school next month, so last week I asked AJN’s Facebook followers for the best piece of advice I could give her. The response was overwhelming: over 600 people offered wisdom, encouragement, and tips for success. I went through and read them all and the following is an attempt to synthesize the advice.

Of course, with so many responses, there were many valuable pieces of advice I had to leave out, from the practical to the profound, such as:

sit in the front of class, stick to your principles, invest in good shoes, choose clinicals that push you out of your comfort zone, be early for everything, celebrate the small victories, get a really good stethoscope up front, believe in yourself, pick the hardest patient you can at clinical, audiorecord the lectures, be truthful and committed to your work, eat healthy, get to know your instructors, coffee and chocolate!

And finally: look into the eyes of your patients and be sure they know you care. Every patient, every time.

(Oh, and not to leave out the lighthearted—Don’t hold your nose in clinicals. The teachers frown on that.)

Below are five areas of advice that stood out:

1) “Take a good picture of your friends and family and put it on your desk, because that’s all you’ll be seeing of them for the next two years.” There were many variations on the idea that nursing school “takes 100% dedication.” You need to warn your family and friends that they won’t be seeing you for a while, get rid of your TV, sleep when you can, learn good time management, and be prepared to spend Saturday nights with your books . . .

2) “Study, study, study, and study some more.” Respect the quantity and degree of difficulty of the material you will have to learn. There were a lot of ideas about how to optimize your studying—chief among them was to get in a study group and to study NCLEX questions from the beginning. Others were to read ahead, not procrastinate, use flashcards, attend practice and review sessions, and have a study partner or buddy system. Having a study buddy, though, is only a small part of the importance of friendships with your fellow students . . . Read the rest of this entry ?

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The Blame Game

April 7, 2014

By Jacob Molyneux, senior editor

TheBlameGameIllustrationThe Reflections essay in the April issue of AJN is called “The Blame Game.” It’s by a nurse who finds herself visiting a family member in the hospital during her shift break at the same hospital. In her distress, she gets little relief or reassurance from the harshly judgmental nurse she encounters.

The vividly told episode raises the question: can the act of casting judgment on another person diminish our ability to see these people as complete human beings, whatever their failings? And also this question: what is the proper attitude of nurses toward their patients?

Please give it a read and see what you think. Is this nurse’s attitude an exception, or more common than it should be, as the author suggests? Here’s a brief quote from near the end:

There seems to be a dangerous epidemic of clinicians blaming patients for their health issues. As a nursing student, I saw more and more of this attitude. The health care profession seems to have evolved a culture of accusation and attack against patients, a group we should be empowering and protecting.

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Recent Nurse Blog Posts of Interest, Inhaled Insulin, a Note on Top Blogs Lists

April 4, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Here you will find some links to nursing blog posts, a look at this week’s Affordable Care Act health exchange enrollment numbers, and a couple of items of interest about new treatments or studies, plus a note on blogs that award other blogs badges. A grab bag, so bear with me if you think it’s worth the time…and remember, there’s no shame in jumping ship mid-post.

crocus shoots, early spring, I think/ via Wikimedia Commons

crocus shoots, early spring, I think/ via Wikimedia Commons

At the nursing blogs:

RehabRN has a post about a friend who was bullied by a nurse of much higher authority in the same hospital. Such stories, if true, are always upsetting. What can you do but take it when the power differential is so great?

At the INQRI blog (I’m not going to tell you what the initials stand for except that it has something to with quality, research, and nursing), there’s a post about why stroke survivors need a team approach to palliative care.

Megen Duffy (aka Not Nurse Ratched) has a really very good post at a site she sometimes blogs for. I already shared it via a tweet yesterday, but it deserves more. It’s called “Nursing Will Change You.”

At Infusion Nurse Blog, there’s a post addressing IV solution shortages (now happening on top of shortages of some common and necessary drugs due to a variety of reasons). It gives some practical steps clinicians and organizations can take to conserve and is definitely worth a quick look.

A sweet little post called “Nursing Sisters” is at Adrienne, {Student} Nurse. It’s about how nurses help each other out, starting right from the beginning in nursing school.

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AJN’s April Issue: Sickle Cell Anemia, Telehealth, Systematic Reviews, FOAMed, More

March 28, 2014

AJN0414.Cover.OnlineAJN‘s April issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Coping with pain in sickle cell anemia. Our April cover features a painting of red flowers in a vase. But on closer inspection, you might notice that the flowers are actually red blood cells, painted by a young girl who suffers from sickle cell anemia. Afflicting about 90,000 to 100,000 people in the United States, sickle cell disease often causes acute and chronic pain syndromes described as being on par with cancer-related pain. Cognitive behavioral therapies, such as the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. April’s original research CE article, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease,” suggests that this technique can be effective for managing pain in school-age children with the disease.

Implementing advances in telehealth. New technologies such as remote monitoring and videoconferencing often emerge before a facility is ready to efficiently integrate them. Sometimes referred to as disruptive innovations, these technologies, while convenient and easy to use, may not be readily accepted. “Telehealth: A Case Study in Disruptive Innovation” discusses the many applications of telehealth, a means of delivering care that is likely to be a part of every nurse’s skill set. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New installment on systematic reviews. Last month, we debuted our new series from the Joanna Briggs Institute on the systematic review. This second installment, “Developing the Review Question and Inclusion Criteria,” provides an overview of the first steps taken when conducting such a review, starting with forming the perfect review question.

#FOAMed. The April iNurse column, “Have You FOAMed?” delves into the new and still evolving social media concept called FOAM, or Free Open Access Meducation. FOAM is an umbrella concept that refers to online media that students and professionals can use to educate themselves and to share and discuss new knowledge and ideas. It spans many social media platforms and is a fast, free way to keep up with the latest in medical knowledge. Read the rest of this entry ?

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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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Three Nurses and a Doctor Go Sailing – Some Notes on Communication Style

March 24, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Untitled from the series, Pareidolia. Charcoal and graphite on paper, 12" x 9," by julianna paradisi

Untitled from the series, Pareidolia. Charcoal and graphite on paper,
12″ x 9,” by julianna paradisi

There’s an old joke about the personality differences among nurses of different specialties. It goes like this:

A medical–surgical nurse, an ICU nurse, an ER nurse, and a doctor go sailing. The doctor stands at the bow of the boat and shouts to the nurses, “Trim the sail!”

The med–surg nurse asks, “How do you want it?”

The ICU nurse replies, “I’ll trim, okay. But I’m doing it my way.”

The ER nurse shouts back at the doctor, “Trim the sail yourself!”

ICU style. The joke is a generalization, of course. However, I was a pediatric intensive care nurse once upon a time, and I have to admit that the ICU nurse characterization resonates with my own experience. Like the nurse in the joke, I always have an opinion, and rarely mind sharing it. In the ICU, if another nurse, a physician, a pharmacist, or respiratory therapist didn’t agree, conversation ensued. My colleague, equally opinionated, would state her or his position. Data was consulted, and then, more often than not, consensus occurred.

And I often learned something from sharing information. It made me a better nurse. I learned to dig in on a position only if patient safety or my license was at risk. Everything else was pretty much negotiable, face-to-face. From this perspective, our ICU team was similar to a marriage—it would have been unrealistic to expect there would never be disagreement within our team. In fact, if there was never disagreement, someone probably wasn’t being honest about her or his feelings—an approach that can lead to passive-aggressive behavior.

I don’t know if it’s because I no longer work in ICU, or if nursing culture in general has changed, but lately I’ve noticed some confusion about the difference between open, honest communication and bullying. There’s a difference. Read the rest of this entry ?

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Working Out the Bugs: Old and Alone in the City

March 19, 2014

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She tweets at @12hourRN.

Old Woman Dozing/Nicolas Maes

Old Woman Dozing/Nicolas Maes

At work the other day, after almost seven years as a nurse, I had an experience that completely floored me. While connecting a bag of cefepime to my tiny, elderly, blind patient’s IV, I spotted a cockroach making its way across her pillow. And then another on her lap. And then they were on the wall behind the bed, coming out of the closet where her belongings were stored. Another nurse had just handed her the pocketbook she’d requested, and the host of insects that apparently called it home were now scurrying quickly around the room, and around me.

I consider myself a fairly brave woman. I can kill a bug if I need to, I see rats quite frequently, and come on, I’m a nurse—there have been some pretty gory things to pass these eyeballs and touch these fingers. But this was different; it was not the hospital grossness that I am a seasoned veteran of. This was a glimpse into my patient’s dirty home. I ran like a little child.

When the situation had calmed down, I talked to my patient about her home, an apartment in Manhattan. How did she get around? How did she get food? She told me that her quest for survival had grown more challenging—that, with no family to care for her, she depends solely on Meals on Wheels, and that she might, after so many years, need to cave in to the pressure and move into an assisted living facility. Although, based on my assessment, she clearly qualified, no doctor had ever offered her a home health aide or visiting nurse.

Cockroaches aside, she is not the first elderly New Yorker I’ve cared for who has no web of support. Living precariously between the poles of health and complete collapse, many of them walk through the city streets for groceries, live on next to no money, and have very little reserve when sickness finally overturns their delicate homeostasis. Read the rest of this entry ?

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Some Florida Inspiration for Nurse Admins and Execs

March 17, 2014

By Shawn Kennedy, AJN editor-in-chief

Zander

Zander

A pep talk on being open to possibility. While it was cold late last week in Orlando, Florida (ok, maybe not so bad at 64 degrees and sunny blue skies, but cold by their standards) the audience at the opening session of the annual meeting of the American Organization of Nurse Executives (AONE) was definitely warmed up after listening to the engaging keynote speaker, Benjamin Zander.

Zander is the conductor of the Boston Philharmonic and a professor at the New England Conservatory of Music. You may be thinking he was probably a bit stuffy and formal, but you couldn’t be more wrong. Zander is, at 75, a dynamo, strolling up and down aisles, exhorting the audience to be likewise expressive, waving arms, smiling and connecting.

His message was to be open to the notion that everything is subject to change depending on how one frames it. He challenged the 1500 listeners to “stand in the realm of possibility.” His message is that everything—the rules, perceptions, games we play—are invented and can be changed. He maintains that every situation can be dealt with three ways: resignation, anger, or recognizing the possibility. Read the rest of this entry ?

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Sexual Assault Survivors, SANEs, and the Nonreport Option

March 14, 2014

Figure 1. Process in the nonreport optionBy Sylvia Foley, AJN senior editor

Until recently, survivors of sexual assault had to make quick decisions about whether to report the assault to law enforcement. Those who chose not to report it weren’t entitled to a free medical forensic examination, and many felt further traumatized by this situation.

The Violence Against Women and Department of Justice Reauthorization Act of 2005 changed this. It added a “nonreport” option, which mandates that survivors be given medical forensic examinations even if they choose not to cooperate with law enforcement or the criminal justice system; states must pay for these medical examinations, regardless. In order to receive certain federal funds, states had to comply by 2009. States have responded in various ways. (Click the image above for an enlarged view of the steps followed in Texas.) But there has been little investigation into the impact of the new provision.

An important question. How has the nonreport option affected survivors, sexual assault nurse examiners (SANEs), and victim advocates? To learn more, Laurie Cook Heffron and colleagues conducted a study in Texas. They report on their findings in this month’s original research CE, “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option.” The following abstract offers a quick overview. Read the rest of this entry ?

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When the Preceptor’s Attitude Is a New Nurse’s Biggest Challenge

March 12, 2014

FirstPreceptorIllustrationHere’s the start of “My First Preceptor,” the Reflections essay in the March issue of AJN.

“Manage your day,” she told me, not for the first time, as if it had been my fault that one patient crashed yesterday just as my second one returned from surgery with a new set of orders. I could not be in two places at once, keeping track of two critical patients, making sure each one received the care she needed at the moment she needed it.

A new critical care nurse has a lot to worry about. It’s easy to feel overwhelmed, even when you’re actually doing a pretty good job. A preceptor can play a crucial role in helping a new nurse find her or his footing. As one might expect, however, some good nurses are not good preceptors. In this essay, the author describes her struggles to deal with the time pressures of her new job, along with her preceptor’s constant admonitions and disapproval.

This fraught nurse–preceptor relationship reaches a crisis point against a backdrop of life and death struggles. I won’t try to summarize what happens in the essay, since different readers may interpret it differently, depending on experience and temperament. But it’s definitely worth a read.—Jacob Molyneux, senior editor

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