Archive for the ‘professional identity’ Category

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Always a Nurse

November 19, 2014

By Janice M. Scully. The author worked in psychiatric nursing for four years before becoming a physician. After 20 years as a physician, she retired to pursue a career as a writer. For more information, click here.

The author's parents

The author’s parents

Nurses have to be resilient and resourceful—Florence Nightingale,  of course, is the template. My mother, Betty, was a smart and practical woman, the oldest of three siblings. She attended nurses’ training in the 1940s while the Second World War raged overseas. I have a photo of her as a young woman just out of high school, dressed in her starched uniform, standing by Binghampton (NY) City Hospital, her alma mater.

According to her, the lives of young nurses back then were not unlike the lives of nuns. After lights out in the dorm, the dorm mother would walk through and shine a light on each bed, as a night nurse on a medical ward at 2 AM might do. But instead of observing for signs of life, dorm mothers were checking to be sure the young female nurses were in their beds. Sometimes they weren’t.

Although the students might not be allowed out at night, they had a great deal of responsibility during the day. Nurses did everything for the sick, even the hospital laundry. They gave bed baths and back rubs in the course of comforting the sick.

During the war, even the most inexperienced nurses had grave responsibilities. When my mother was a new graduate, with few nurses and physicians on the home front, she was placed in charge of a woman’s surgical unit, admitting the fresh post-ops almost single-handedly, taking orders, hanging blood transfusions, managing wounds. A new medication, called penicillin, was available in the hospital, but so expensive that any nurse dropping a vial accidentally, as my mother did, would get severely reprimanded.

My mother had stories. One day a woman admitted for a surgical disorder became suicidal and jumped out of a hospital window, only to return to women’s surgical in a body cast. To my mother, this was a particularly horrifying case.

Her hospital nursing career was short, as were many women’s careers in the aftermath of the war. Though she quit hospital nursing in 1946 when my father returned from the navy—feeding customers in the family restaurant they built together—in a sense, she always took care of people.

Mom ran the kitchen, Dad the bar. Salesmen would follow her around with their clipboard—and I would follow, too, listening to her ordering cans of string beans and pickle slices, cases of chicken.

She had five children within seven years. Our family lived upstairs over the restaurant and my mom balanced both worlds. It wasn’t easy, which is something I appreciate now more than I could when I was a child.

But it seems she never forgot she was a nurse. During my frequent bouts of strep throat, in soft whispers she would confer with the family doctor by phone and, before I knew it, I could hear the glass syringe and needle boiling on the stove in a little metal pan. Then she’d draw up the penicillin from a vial she kept in the refrigerator. I would cringe in my room, waiting for the shot that was sure to come in my backside. But it always made me well, ridding me of my fever and throat pain.

Mom would also give neighbors their prescribed shots of this or that, such as vitamin B12, as if running a sort of mini-clinic in the restaurant kitchen. She volunteered to help a neighbor administer a daily exercise routine prescribed for her infant with Down syndrome. My mother was always, in a sense, a public
health nurse. Read the rest of this entry ?

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As the VA Regroups and Recruits, The Words of Nurses Who Served

November 14, 2014

By Amanda Anderson, a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week. The AJN articles linked to in this post will be free until the end of December.

Vietnam Women's Memorial, courtesy of Kay Schwebke

Vietnam Women’s Memorial, courtesy of Kay Schwebke

A scandal earlier this year about suppressed data related to long wait times for appointments tainted the credibility of the Department of Veterans Affairs. On this Veterans Day week, the new secretary of Veterans Affairs has been using incentives and promises of culture change to promote new hiring initiatives for physicians and nurses. The focus as always should be on the removal of the barriers many veterans face in obtaining timely, high quality care. Naturally, a number of these veterans are nurses themselves.

To commemorate those who have bravely cared for our country, and who deserve the best of care in return, we’ve compiled a few quotations from nurse veterans who’ve written for or been quoted in AJN about their experiences in successive conflicts through the decades. Thank you for all your service, and for what you carry daily—as nurses, veterans, and patients.

World War II
“I remember walking through cities leveled by bombs, looking at the hollow eyes and haunted faces of a devastated civilian population. Since September 11, I see those same hollow eyes and haunted faces on the nightly news.”
—Mary O’Neill Williams, RN, “A World War II Army Nurse Remembers,” as told to her daughter. Published September 2002

Korea
“The challenges and responsibilities of combat nursing far exceeded the normal scope of nursing practice. Army nurses independently triaged casualties, started blood transfusions, initiated penicillin therapy, and sutured wounds. They monitored supplies and improvised when necessary. . .They often cared for 200 or more critically wounded soldiers in a standard 60-bed MASH; off duty, they provided food and nursing care to the local populace. Some managed to be innovators on the cutting edge of nursing practice. The nurses of the 11th Evacuation Hospital helped to pioneer the use of renal dialysis nursing and were among the first to support patients who had hemorrhagic fever using a first-generation artificial kidney machine.”
—Mary T. Sarnecky, DNSc, RN, CS, FNP, “Army Nurses in ‘The Forgotten War,’” November 2001

Nurse Lynne Kohl during Vietnam War. For more information, see article link to right.

Nurse Lynne Kohl during Vietnam War. For more information, see article link below.

Vietnam
“The guys loved the helicopters because, whenever the helicopter was coming in, their lives were going to be saved. . . But helicopters to the nurses meant, ‘Oh my God, how many are coming in?’. . . That’s when we had to run to the ER, get them out of the chopper, get them triaged, get them to where they needed to be. So for us, helicopters meant that people’s lives were at stake. We needed to move fast.”
—Diane Carlson Evans, RN, as told to Kay E. Schwebke, MD, MPH, in “The Vietnam Women’s Memorial: Better Late Than Never,” May 2009. (See also a collection of free podcasts on AJNonline.com that include short poems written and read aloud by nurses who served in Vietnam and an author interview about the creation of the Vietnam Women’s Memorial.) Read the rest of this entry ?

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A Nurse’s Legal Duty to Discern Potential Harm and Protect Patients

November 7, 2014
Illustration by Janet Hamlin for AJN.

Illustration by Janet Hamlin for AJN.

By Jacob Molyneux, AJN senior editor

The November installment of AJN’s Legal Clinic column by nurse and attorney Edie Brous, “Lessons Learned from Litigation: The Nurse’s Duty to Protect,” describes a case in which nurses were held responsible for not adequately protecting a sedated patient from a sexually predatory physician. The case description begins this way:

NX was a young woman who underwent a laser ablation of genital warts at Cabrini Medical Center in New York City. While still under the effects of general anesthesia, she was transferred to a small, four-bed section of the recovery room. Shortly after her admission to the recovery room, the nurses admitted another patient to a bed two feet away from NX. The curtains were not drawn and there were no patients in the other two beds.

A male surgical resident, Andrea Favara, entered the recovery room wearing Cabrini scrubs and Cabrini identification. Residents were not directly assigned to the recovery room and were seldom called there. The nurses knew all of NX’s physicians but did not know Favara; he wasn’t one of NX’s physicians . . .

The details that follow are disturbing. After describing the case and the failure of nurses to confront this unknown physician or actively monitor his interactions with the patient, Brous sketches the ensuing legal machinations, as well as the ultimate decision of an appeals court. Some of the main take-home points for nurses are as follows: Read the rest of this entry ?

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AJN in November: Palliative Care, Mild TBI, the Ethics of Force-Feeding Prisoners, More

October 31, 2014

AJN1114.Cover.OnlineAJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

Palliative care versus hospice. For many seriously ill, hospitalized older adults, early implementation of palliative care is critical. These patients often require medically and ethically complex treatment decisions. This month’s original research article, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults,” found that staff nurses often confuse palliative and hospice care, a fact that suggests a need for increased understanding and knowledge in this area. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Mild traumatic brain injury (TBI) can have profoundly negative effects on quality of life and can negatively affect relationships with family and caretakers. This issue’s other CE feature, “Mild Traumatic Brain Injury,” reviews the most commonly reported signs and symp­toms of mild TBI, explores the condition’s effects on both patient and family, and provides direction for devel­oping nursing interventions that promote patient and family adjustment. Earn 2 CE credits by taking the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, in our iPad app, by tapping the icon on the first page of the article).

Medication safety. While preparing medications in complex health care environments, nurses are frequently distracted or interrupted, which can lead to medication errors. “Implementing Evidence-Based Medication Safety Interventions on a Progressive Care Unit,” an article in our Cultivating Quality column, describes how nursing staff at one facility implemented five medication safety interventions designed to decrease distractions and interruptions during medication preparation. Read the rest of this entry ?

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Ebola: A Role for Nurses in Sharing the Facts

October 29, 2014

By Shawn Kennedy, AJN editor-in-chief

Screen Shot 2014-10-29 at 12.27.27 PMThe current Ebola crisis has everyone concerned over transmission, and rightly so. The public has been in a quandary as to who and what to believe. I can’t say I blame them. We should have been better prepared and anticipated that, given the situation in West Africa, we would eventually see a patient with Ebola present to a U.S. hospital ED (or clinic or urgent care center). What’s surprising is that it didn’t happen sooner.

I’d thought fears about widespread transmission of Ebola had abated after no more new cases arose from that of Thomas Eric Duncan in Dallas: his family, who were in the apartment with him during the time he was sick, did not contract Ebola and have since been released from quarantine; the two nurses who became ill treating Duncan have now been declared Ebola free and none of their contacts have become ill; no other nurses who provided care for him have fallen ill.

But with the onset of confirmed Ebola in a New York physician who had recently returned from caring for Ebola victims in West Africa, fears of widespread contagion resurfaced. Craig Spencer had been self-monitoring his symptoms while he went about his life; when he began to feel ill and developed a low-grade fever, he initiated a controlled transport in isolation to Bellevue Hospital.

And when nurse Kaci Hickox returned from volunteering in West Africa, she was caught in New Jersey’s new Ebola precautions and placed in mandatory quarantine in a tent outside a hospital in Newark. She protested, secured attorneys to advocate on her behalf (basing her protest on CDC recommendations that routine quarantine of nonsymptomatic health care workers is not justified), and was released to travel home to Maine, where she is now disputing Maine’s mandatory in-home quarantine and active monitoring requirement in favor of self-monitoring. Read the rest of this entry ?

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10 Good Things About Being an Older Nurse

October 3, 2014

Alice Facente, MSN, RN, is a community health education nurse in Connecticut. Her Reflections essays, “At Her Mercy” and “The Dirtiest House in Town,” were published, respectively, in the August 2009 and January 2010 issues of AJN.

Puddle Reflection/by joiseyshowaa, via Flickr

Puddle Reflection/by joiseyshowaa, via Flickr

I recently passed a professional career milestone: 40 years since I’d graduated from nursing school. When I began my career, nurses still wore white starched caps and white uniforms. I don’t know how we accomplished everything we did with those impractical caps perched on our heads. The shocking realization that four decades had so quickly passed forced me to think about all of the benefits of being a mature, experienced nurse. Right off the top of my head, I thought of 10 things (and yes, these are generalizations and exceptions exist).

1. Older nurses are often more empathetic. Chances are that in the last several decades every older nurse has been a patient, undergone surgery, become a parent and possibly a grandparent, encountered personal financial challenges, experienced the death of a close friend or family member, and much more.
2. Death is not so frightening. Nurses have cared for people at all stages of the life cycle and know that, with planning and preparation, the end of one’s life can be peaceful and dignified.
3. We are not easily fooled. There is not too much that we haven’t seen or heard in 40 years.
4. Computer crashes don’t bother us. In fact, who do they turn to when they have to chart using the “old fashioned” pen and paper method?
5. We have X-ray vision. Years of experience have fine-tuned our assessment skills.
6. We have accumulated simple “tricks of the trade” like the heel-drop test for appendicitis or checking conjunctiva pallor for anemia. Read the rest of this entry ?

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Unbalanced: The Art of Changing Nursing Roles

October 1, 2014
Bull and Monkey/ graphite, charcoal, acrylic on vellum/by julianna paradisi

Bull and Monkey/graphite, charcoal, acrylic on vellum/by julianna paradisi

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

The culture shock experienced by new nurses making the transition from student to professional is well documented. Less well documented is the culture shock seasoned nurses face when changing jobs. Not all nurses are the same. Neither are all nursing jobs.

Working in an unfamiliar setting means being the new guy. You may have been in the top 10 of your nursing class for grades and clinical excellence. Or you may have held a position of leadership in your previous unit. In your new job, you are unknown and unproven.

For nurses changing jobs from high-acuity areas—ICU or bone marrow transplant, say—to an ambulatory clinic, the stress is twofold.

First, there’s a period of grieving the loss of hard-won skills and certifications that are not applicable in the new role.

Then there’s the shock that your skills and experiences did not prepare you for the outpatient setting. Often, the first realization is that high-acuity patients have central lines, so a nurse migrating from such a practice area may not have strong peripheral IV skills.

By contrast, placing peripheral IV’s is something outpatient infusion nurses do all day long; IV placement skills are learned over time through practice. The nurse experienced in high-acuity patient care is suddenly a beginner, often needing the help of coworkers to insert IV’s in patients. The inability to consistently start a peripheral IV is frustrating for the nurse and for coworkers, not to mention the patient.

I’ve been thinking a lot about how it feels to be new at a job, because of the changes at mine (see earlier post, “The ACA and Me: A Dispatch from the Trenches”). Although my job is basically the same job that it was, the oncology piece has greatly expanded, and I’ve worked hard to become familiar with numerous chemotherapy regimens. Read the rest of this entry ?

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