Archive for the ‘Nursing perspective’ Category


Workplace Bullying: One Medical Center’s Nurses Assess and Respond

February 9, 2016
photo by Ronald Keller

photo by Ronald Keller

Bullying against or by nurses has gotten a lot of attention in recent years. Aside from the suffering bullying inflicts on its victims, research tells us that bullying (which takes a number of forms, from overt insults to more subtle acts that undermine and demoralize) can also endanger patient safety and quality of care.

As described in our February article, A Task Force to Address Bullying (free access until March 1), recently a large Magnet-designated academic medical center in the Northeast developed an initiative to evaluate and address the issue at their institution. In order to first measure the problem, the task force developed a confidential online survey.

The survey had a 38% response rate. Here are some of the findings about who’s doing the bullying, who’s suffering it, and how its victims are affected by it:

 . . . . two-thirds (66%) of respondents reported having experienced or witnessed bullying in the workplace; and ‘bullies’ were most frequently identified as staff nurses (58%), followed by physicians (38%), patient care technicians (34%), and nurse managers (34%). Among the individuals who reported having been bullied, more than half experienced the following personal consequences: loss of confidence (63%), anxiety (59%), and diminished self-esteem (50%); and more than half experienced the following work consequences: decreased job satisfaction (83%), decreased teamwork and collaboration (72%), and impaired communication (63%)

When asked how they dealt with the bullying, 58% of participants said they discussed the situation with family or friends, 53% ignored the bully, 42% spoke to their nurse manager, 41% confronted the bully, and 30% considered resigning.

It’s obvious that bullying is far too common, and highly damaging in a number of ways. The task force developed a plan to address bullying, sharing the survey results with hospital staff and starting a slogan-based program called the Be Nice Champion program. Central to the plan was promotion of “third-party intervention,” not to confront the bully but to support the victim and short-circuit the isolating effects that being bullied can have. Read the rest of this entry ?


‘A New Antibiotic’: What Restores a Patient’s Will to Recover?

February 5, 2016
Illustration by Pat Kinsella. All rights reserved.

Illustration by Pat Kinsella. All rights reserved.

A little bit of levity when writing of serious topics can be good medicine. This month’s Reflections essay, “A New Antibiotic,” reminds us of how important it can be for hospitalized patients to be kept in touch with their lives and loves beyond hospital walls. In this story, author Judith Reishtein, a retired critical care nurse and nursing professor, finds herself willing to bend the rules a little for one patient. Here’s how it starts:

Sally had been a patient on the step-down unit all winter. After her open heart surgery, she developed an infection in her chest. The infection required another surgery and four more weeks of ventilator support as her open chest healed. Because she was not moving enough, she developed clots in her legs. Because of the DVTs, she had activity restrictions, which led to another bout of pneumonia. One complication led to another, with more medications that had to be carefully balanced. We tried not to do anything that would create a new problem while curing an existing one.

Now she was finally getting better, but her energy lagged behind. Did she still have the will to heal? I worried about that; I had seen too many patients slide from lassitude into the grave. I wasn’t sure if she could recoup her energy and will to live; but her daughter Trudy knew exactly what would strengthen her spirit…..

We hope you’ll read the rest of this short, free access essay, and see how it turns out. There’s a deeper truth hidden here, whatever your take on this nurse’s compassionate decision to allow a certain type of visitor on the unit.—Jacob Molyneux, senior editor 



Hospital Shootings: Unacknowledged Job Hazard?

February 3, 2016

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Active_shooter_post_illustrationRecently, while preparing for work, I received the following text from a coworker already at the hospital:

We’re on lockdown
Armed gunman
Stay home, they announced “active shooter now outside building”

Shocked, barely able to comprehend the message, I texted back:

Are you safe?

She texted back that she and others were in lockdown in the cafeteria. Numbly, I switched on the TV, looking for more information, but found nothing. Not a single report of the event on any station. Turning to the Internet, I found a single tweet referring to an event in progress. Feeling helpless, I texted my husband and daughter and then called my mom, letting them know I was at home, safe, just in case they heard something. Then I waited.

Within an hour, the same coworker texted again:

All clear!

I stared at my phone, not knowing what to do. I went to work.

The resolution of the shooting situation was heartbreaking. However, no patients or hospital staff were harmed. The outcome could have been much worse.

That evening, local media coverage of the crisis remained scant to the point I nearly felt I’d imagined it. It was as though it never happened.

We were lucky. Our shooting occurred outside, on the hospital grounds—as do 41% of hospital shootings, according to a study in the Annals of Internal Medicine. However, 59% occur inside hospitals, endangering patients and staff. Furthermore, the rate of occurrences, inside or out, is increasing.

Hospital staffs have trained for years to handle fire, child abduction, and disasters, man-made or natural. However, the realization that hospitals are soft targets, similar to schools, shopping malls, and movie theaters, dawns more slowly.

Managing a rapidly evolving and unpredictable crisis can be beyond our control. To stay and protect patients may prove impossible. Some coworkers may or may not choose to stay with their patients; you will have to decide whether or not to abandon them too. Ethical choices may come into play—I for one struggle with the concept of abandoning patients. Teachers live with this fear on a daily basis.

According to the 2015 document, Active Shooter Planning and Response in a Healthcare Setting, from the Healthcare and Public Response Sector Coordinating Council, there are a number of ways to prepare a hospital in practical terms for an active shooter situation, and also to understand the kinds of decisions that may become necessary: Read the rest of this entry ?


Rightness: A Flight Nurse Taps Into the Universal Language of Nursing

February 1, 2016

“Immersed in a nursing role that I didn’t even know existed when I entered the profession, I find there to be a common language—one rooted in science but strongest in humanity and compassion, transcending culture, geography, and words.”

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

MarcyPhipps_Flight_NursingI’m standing in the doorway of our plane, watching our patient sleep and eyeing the monitor. The monitor’s beeps keep steady time and mix with the sounds of the pounding waves that batter the atoll.

We’ve stopped for fuel on this narrow runway that stretches down a spit of land in the Pacific. As the sun rises we snack on cold gyudon, a Japanese dish we picked up in Guam. It’s not the best breakfast, but somehow feels right—like a lot of other aspects of this job lately.

We’d started our mission in eastern Asia, picking up an American citizen who’d fallen ill in a city that didn’t cater to tourists and where almost no one spoke English.

While there, our crew’s handler—someone whose job it is to facilitate our lodging, transportation, and generally ease our way—had taken us to a dimly lit restaurant on a back street and treated us to a myriad of local delicacies, some of which I recognized, many of which I didn’t. My usual morning run had led me through parks and a street market crowded with live chickens and full of fruits and vegetables I’d never seen.

But the ‘rightness’ I felt was owed entirely to the experience I had at the foreign hospital. Read the rest of this entry ?


Neither Snow, Sleet, Hail, nor Major Blizzard: Business as Usual for Nurses

January 28, 2016

By Shawn Kennedy, AJN editor-in-chief

ShawnKennedyThe snowbanks in the New York area are already starting to melt, but it’s worth noting that this past weekend’s massive storm was business as usual for nurses. The New York Daily News carried a story earlier this week of a practical nurse who got a babysitter for her daughter and then walked through the height of a recent blizzard to get to her job at a nursing home.

Chantelle Diabate, who works at the Hebrew Home in Riverdale, New York, walked a mile in the snow and wind to get to work. She has been working there for six months as an LPN and said she knew they’d need her because many staff would be unable to get there. She stayed through the weekend.

by doortoriver, via Flickr

by doortoriver, via Flickr

AJN’s publisher, Anne Woods, works every Saturday as a cardiothoracic NP in a hospital near Philadelphia. With the imminent arrival of the storm on Friday afternoon, Woods went to the hospital that afternoon and spent the next 36 hours there as the only NP on duty in critical care. About 100 other staff stayed through the night, too. Woods noted that the camaraderie was uplifting, with physicians pitching in alongside nurses. Monday, Woods resumed her publishing work.

At the National Institutes of Health (NIH) in Maryland, on a pediatric bone marrow unit, the children were looking wistfully out at the falling snow of the blizzard. Given the conditions, it wasn’t safe for them to go outside, but nurses went out, filled up tubs with snow, and the young patients spent the afternoon making snowmen.
Read the rest of this entry ?


What to Know About Zika Virus

January 26, 2016

By Shawn Kennedy, AJN editor-in-chief. Accompanying map via PAHO/WHO.

The media is full of headlines and photos about the recent increase in the number of Brazilian children born with microcephaly, thought to be due to maternal exposure to the Zika virus. If you’re like most nurses, you’ve had family members and friends asking you about it, especially if they’re considering a winter escape to the Caribbean or Mexico. Here are some resources and information to help you stay up to date so you can provide your patients (and families and neighbors) with evidence-based information.


Zika basics. Zika virus was first discovered in 1947 in monkeys in the Zika forest of Uganda and the first documented case in humans was in 1952. An outbreak on Yap Island in Micronesia in 2007 showed that it had spread beyond Africa. The virus is spread by the Aedes mosquito, the same mosquito that transmits yellow fever, dengue, and chikungunya.

Outbreaks of Zika have been spreading northward from Brazil through the Americas since 2014. (See above PAHO/WHO map of confirmed cases, 2015-2016.) While most transmission is believed to occur via mosquito bites, according to the CDC, “Perinatal, in utero, and possible sexual and transfusion transmission events have also been reported. Zika virus RNA has been identified in asymptomatic blood donors during an ongoing outbreak.”

Symptoms and course are similar to those of other viruses: a few days to a week of fever, headache, arthralgia, rash. Conjunctivitis has also been reported. Treatment is usually limited to supportive care (fluids, rest, etc). Only one-fifth of those infected become symptomatic, and death is rare. However, outbreaks of Zika virus have also been recently associated with neurologic syndromes (Guillain-Barré, meningitis, meningoencephalitis, myelitis).

Zika and pregnancy: emerging concerns. Everyone paid attention when, in late 2015, Brazil reported a sharp increase in the number of infants born with microcephaly. According to reports from WHO, from 2010 to 2014 the national average number of microcephalic infants born was 163. But in 2015, there were 3,530, with most occurring in northeast Brazil and late in the year. Zika virus was found during autopsy in microcephalic infants with other anomalies and in the amniotic fluid of some of the mothers, suggesting an association. (It’s important to note, however, that there may be other factors involved, given the clustering of cases in northeast Brazil while increased incidence of microcephaly have not been widely reported elsewhere. This is an evolving story and the investigation is ongoing.) Read the rest of this entry ?


Ethical Practice with Patients in Pain

January 20, 2016
Photo @ AJ Photo / Hop Americain / Science Photo Library

Photo @ AJ Photo / Hop Americain / Science Photo Library

Pain is difficult to define and hard to convey. The way both patients and clinicians respond to it can be influenced by a multitude of possible biases. This month’s Ethical Issues column in AJN is by Doug Olsen, PhD, RN, an associate professor at Michigan State University College of Nursing. In “Ethical Practice with Patients in Pain,” Olsen summarizes the challenge nurses and other clinicians face in treating patients’ pain:

Responding to a patient’s pain is a fundamental ethical obligation in nursing. However, nurses caring for patients in pain can run into ethical conflicts from both over- and undertreatment of pain. Undertreatment of pain represents a failure to fulfill the core nursing obligation to alleviate suffering—but overtreatment may ultimately harm the patient, contradicting a core nursing value, nonmaleficence. The complex nature of pain complicates efforts to provide treatment that is ‘just right.’ Nurses must understand that complexity if they are to make ethical decisions in the care of patients who experience pain.

Read the rest of this entry ?


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