Archive for the ‘professional identity’ Category

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Revisiting Reality Shock – What’s Changed for New Nurses?

July 28, 2014
julie kertesz/ via flickr creative common

julie kertesz/ via flickr creative common

By Maureen Shawn Kennedy, AJN editor-in-chief

Last month, we highlighted on Facebook a blog post I had written in 2010, “New Nurses Face Reality Shock in Hospital Settings – So What Else is New?” (It seemed timely in terms of all the June graduations.)

I wrote that original post in response to a study that had just been published in Nursing Outlook (here’s the abstract) describing the experiences of new nurses. Generally, these newbies felt harried, unprepared, overworked, and unsupported—all similar concerns voiced by nurses in Marlene Kramer’s 1974 book, Reality Shock: Why Nurses Leave Nursing. (Here’s AJN’s 1975 review of the book. It will be free for a month; note that you have to click the PDF link at the article landing page to read it.)

My post back in 2009 noted how nothing much seemed to have changed since the publication of Kramer’s book. Now, once again, this post has generated many comments, a number of them on our Facebook page as well as on the original blog post.

Here are a few. I’ll start with Facebook:

I’m almost a 20yr RN and have experienced [this] in a new job. I’ve developed skills to deal with this over the course of my career, so it doesn’t impact me like it did as a new nurse…but to new nurses out there: just know that bullies have some personality disorder that extend[s] beyond the workplace (even if you never get to see it). Learn, be happy, and go on your way. It’s them, not you.

It’s up to nursing leaders at all levels to set the expectations and role model professional behavior.

The real problem is that we will no longer want to work as nurses . . . it has become so difficult for so many reasons. So at the end of a long shift you wonder, “Is it worth it? Is it?”

And some comments from the blog: Read the rest of this entry ?

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The Ethics of a Nurse’s Refusal to Force-Feed Guantanamo Hunger-Strikers

July 18, 2014

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons

The Miami Herald reported this week that a U.S. Navy nurse and officer refused to take part in force-feeding hunger-striking detainees at Guantanamo Bay.

There’s much we still don’t know about this story, but the force-feeding of prisoners at Guantanamo has been a contentious issue for some time. The practice has been compared by some to torture, and ethicists in the medical literature have urged the physicians involved to refuse to participate, while the U.S. government and President Barack Obama defend the practice on humanitarian grounds of preventing the deaths of the detainees.

Whether or not one feels that nurse participation in the force-feeding is justified, this officer, whose identity has not been released, appears to deserve the profession’s praise for taking a moral stand in an extraordinarily difficult circumstance. All nurses have the right of conscientious objection, of refusing to participate in practices that they find morally objectionable—assisting in abortions is another practice that some nurses have opted out of on moral grounds—and officers in the U.S. armed services are bound to consider the legality and morality of orders they carry out.

Much is at stake for this nurse. Not only do officers risk their careers when refusing an order on moral grounds, but they must breach a sacred principle of effective military operation: obedience to the chain of command except by an officer in extraordinary circumstances.

Further, the officer deciding to refuse an order must make this determination alone and accept severe consequences if the further consideration of the higher chain of command, the courts, or history does not support her or his assessment. Read the rest of this entry ?

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Flight Nursing Notes – The Feel of a Homecoming

July 14, 2014

Observations of an experienced ICU nurse and long-time AJN blogger who recently made the transition to flight nursing.

clouds-photo-from-airplaneMarcy Phipps, BSN, RN, CCRN, ATCN, TNCC, is an occasional contributor to this blog. Some details have been changed to protect patient privacy.

“We’ve been married for 58 years,” my patient’s wife says. “Fifty-eight years…”

She turns her attention from me and gazes out the window of the plane.

We are on a medevac flight, 35,000 feet over the Pacific en route to an urban, American hospital near “home.” Her husband is being transferred to receive aggressive care for a grave illness.

We collected him hours earlier from a hospital on a foreign island. Local paramedics picked my partner and me up from the barren, windy tarmac. As we sped to the hospital in the back of an ambulance with a cracked windshield, the driver turned to warn us that we were going to “the worst hospital in the city.”

“It’s open-air,” he told us, as he dodged mopeds and swerved through narrow, crowded streets.

This didn’t surprise me. I’d been forewarned that hospital conditions on many of these remote islands could be shocking when compared to American standards. It was something I’d been curious to see firsthand.

Yet when we picked our patient up, we found him in a small and clean room in an intensive care unit. Despite the paramedic’s prediction and the visibly run-down hospital, he appeared well cared for and attended to. His wife told me later that she believed her constant presence at his bedside had guaranteed his good care.

And now it’s two in the morning and I sit in a private jet with the flight medic, tending our patient, who is remarkably stable and tolerating the flight with ease. We are also tending to his wife, albeit in less obvious ways. He’s secured to a stretcher; she sits in a bucket seat at his feet, nervously watching his chest rise and fall with the ventilator-delivered breaths. Each time I assess him or check his vital signs she looks at me anxiously. Read the rest of this entry ?

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As Another June Is Forgotten, Some Notes on Nurses and Normandy

July 3, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

A pause before the 4th of July: Nurses were at D-Day too.

NormandyNursesLanding

Nurses coming ashore at Normandy/AJN archive

Last month, there were a number of D-Day remembrances in the media—June 6 was the 70th anniversary of the 1944 Allied forces landing along the beaches of Normandy and what many believe to have been the single largest tactical maneuver ever launched.

I was especially interested in the D-Day events—I’ll be visiting the Normandy beaches in October. My father was a World War II army veteran and landed at Normandy, though not in the first wave. He arrived days later with Patton’s 9th Armored Division after the beaches had been secured. (His unit would go on to fight in the Battle of the Bulge and finally into Germany after securing the Bridge at Remagen, the only bridge across the Rhine River into Germany not destroyed during the German retreat.)

ItalyNursesLanding

AJN archive

One thing I was surprised to learn is that nurses landed at Normandy and other invasion beaches within only a few days of the first wave. The photos here are from the AJN archives—the above photo shows nurses landing at Normandy. And the one to the right predates Normandy and shows nurses disembarking in April, 1944, in the harbor at Naples, Italy. (According to this article from the AJN archives, which describes nurses coming under fire while treating wounded troops at the Anzio Beachhead, nurses arrived shortly after troops landed on Italy’s shores in the fall of 1943. For the best version, click the link to the PDF in the upper- right corner of the article page.) Read the rest of this entry ?

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A Child’s Story, or Why She Became a Nurse

June 30, 2014
Illustration by Anne Horst. All rights reserved.

Illustration by Anne Horst. All rights reserved.

Day in and day out, a child lives in fear. Her stomach often twists in knots of pain for hours before the pain fades away. The doctors can find no medical reason for the pain. Her mother angrily accuses her of faking it, of being more trouble than she’s worth. The child is often told how stupid she is. Though her father sometimes protects her, at times his medication doesn’t work and he transforms from a caring protective father into a crazed abusive one. Even when the child is unharmed, she stays in a constant state of panic as soon as she walks in her front door.

That’s the opening paragraph of this month’s Reflections essay. “A Child’s Story” is a tough read. It’s about child abuse, helplessness, the will to endure, about those who help and those who don’t. In the end, it’s a hopeful story, despite everything. The story is also a reminder of just how much the decision to become a nurse means to some people. Here’s a brief excerpt, but we hope you’ll read the entire short essay (click on the article title above).—Jacob Molyneux, senior editor

 

 
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Providing Culturally Sensitive Care: It Takes More Than Knowledge

June 25, 2014

By Karen Roush, AJN clinical managing editor. Photos by the author.

DSC_0136One Saturday a few weeks ago I grabbed my camera and headed out to spend the afternoon taking photographs around the city. I ended up wandering around the streets of Chinatown, photographing the street life—the rows of fresh fish on piles of ice, the colorful patterns of vegetables in crates outside shops, old women in variations of plaid and flowered housedresses lined up on a bench, children scattering clusters of pigeons.

Eventually I happened upon a vigorous and highly skilled game of handball in a park. The competitors were predominately young Asian men, though there were a few Hispanic men playing too. Standing next to me, a young man was telling his friend about a clever way a mutual friend had devised to get out of paying a parking ticket. If you live in New York, or almost any big city, you will earn yourself a parking ticket or two at some point. Intrigued by this man’s idea, I asked him if it actually worked and he assured me it did. Then he rolled his eyes and said, “Oh no, I shouldn’t have said anything. Once the white people know, that’s the end of it!” Read the rest of this entry ?

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Takeaways from 2014 ANA Membership Assembly

June 23, 2014
Pamela Cipriano, incoming ANA president

Pamela Cipriano, incoming ANA president

By Maureen Shawn Kennedy, AJN editor-in-chief

So far, so good

In June, the American Nurses Association (ANA) convened its second membership assembly, which included representatives of constituent and state nurses associations, individual members groups and affiliated entities, plus the board of directors. (This is the structure that replaced the House of Delegates as the official governing body of the ANA, when ANA restructured in 2012. See our 2012 report on the restructuring.)

The assembly was preceded by ANA’s annual Lobby Day on June 12th, in which nurses visited legislators on Capitol Hill to talk up legislation important to nursing, like bills on staffing, safe patient handling, and one that would remove barriers to efficient home care services.

This membership assembly was subdued—perhaps a gift for Karen Daley, the outgoing two-term president who shepherded the organization through a turbulent period of change. There were no contentious resolutions to deal with this time—there were only three issues brought to the group through dialogue forums, to develop recommendations for the board of directors:

  • scope of practice (full practice authority for all RNs)
  • integrating palliative care into health care delivery
  • promoting interprofessional health care teams

While the scope of practice topic was ostensibly promoting full practice for ALL RNs, most of the discussion (and a video) focused only on APRNs as physician colleagues. I wonder: are we fostering a message in which only nurses who are APRNs are perceived as physician colleagues? Read the rest of this entry ?

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Still a Nurse: A Shift in Professional Identity

June 19, 2014
Illustration by Jennifer Rodgers. All rights reserved.

Illustration by Jennifer Rodgers. All rights reserved.

The June Reflections, “Making It Fit,” is a frank exploration of the ways health care professionals form separate cultures within each institution. It’s told by a newly minted advanced practice nurse whose previous job had been as a staff nurse in an ED. Now she’s taken a job as a psychiatric NP and finds herself on uncertain ground:

When I walked onto the unit my first day, expecting to be embraced by the nurses, I was dumbfounded and hurt that my own profession didn’t accept me with open arms. The inpatient unit is a melting pot of professions, and I found that I didn’t necessarily fit with the doctors, the social workers, or the staff nurses.

The author finds herself alone, neither nurse nor physician but instead something in between. As she describes her process of finding a new kind of nursing identity, she is very clear that this is not a case of nurses “eating their young.” Rather, it’s about finding a new normal. The short essay is an honest, smart look at career advancement and the associated challenges we hear less about, and is well worth a read.—Jacob Molyneux, AJN senior editor

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The Ethics of No-Smokers Hiring Policies: Examining the Assumptions

June 16, 2014
Army nurses light up in 1947. Photo courtesy of Everett Collection / Newscom.

Army nurses light up in 1947. Photo courtesy of Everett Collection / Newscom.

By Jacob Molyneux, senior editor

The Ethical Issues column in the June issue is called “The Ethics of Denying Smokers Employment in Health Care” (free until July 16). As in his previous columns, nurse–ethicist Doug Olsen models the thinking process of an ethicist, illuminating the fundamentals of ethical reasoning even as he tackles a specific ethical question.

Most positions we take on tough questions depend on a number of assumptions, both conscious and otherwise. In this article, Olsen does a great job identifying and then testing the assumptions that underlie such no-smokers hiring policies. Here are the main ones, as Olsen describes them:

  • Personal responsibility applies to smoking—that is, the individual is responsible for the smoking behavior.
  • There is a positive cost–benefit ratio in denying smokers employment.
  • Patient care is improved by not having smokers on staff.
  • Smokers can be reliably identified.
  • Smokers are not being singled out—people with other equally unhealthy behaviors meeting the criteria on this list are treated in the same way.
  • Refusing to employ smokers is good publicity for the hospital and therefore improves the hospital’s ability to fulfill its mission.

After considering the defensibility of each of these assumptions in turn, Olsen makes a distinction between what he calls “restrictive” and “caring” policies, and considers the potential effects of each on public perception when it comes to a hospital. Read the rest of this entry ?

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When Metrics and Testing Replace Listening and Physical Assessment

June 13, 2014

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

Emergency x 2 by Ian Muttoo, via Flickr.

by Ian Muttoo/via Flickr

I was appalled as I read the Narrative Matters column by physician Charlotte Yeh in the June issue of Health Affairs, for two reasons. Aside from the compassion I felt for her suffering at being hit by a car on a rainy Washington, D.C., evening in 2011, I was dismayed that most of her story took place in an ED, one of the settings in which I used to work. While there, she met with a series of omissions that included not just medical care omissions but also—though she never explicitly connects the dots—basic and serious nursing care omissions.

It saddens me to think that one of the things I fought so hard to implement on our unit more than 20 years ago—transforming the staff’s automatic labeling of arriving patients (an MI, an MVA, a gunshot wound) into a unique picture of who that patient really was under those traumatic circumstances—has still not come to pass. Yet that change of vision is so important to completing the picture and arriving at an accurate diagnosis. Noting that her care demanded a better balance of necessary test-based care and “an understanding of me as a person and what mattered to me,” Yeh points out how, for many providers, the clinical measures “can become more important than the patient.”

She narrates her view from the hallway stretcher as the ED team looks at cursory objective data only—some negative test results, the fact that she was not lying in the street when EMTs arrived (she had been moved by bystanders at her request, to avoid being run over by oncoming traffic), and that meds relieved her pain. But the objective signs that could have been gotten only from listening to her and from a solid nursing assessment were ignored for far too long.

I would expect a Level 1 trauma center team to know that clinical measures form only the tentative outline of a complete patient picture. Yet Yeh did not even receive a thorough history and physical from any member of the team. Yeh is a physician and understandably focuses her finger-pointing on medical care, which failed to order the tests that might have clarified the outline of what was happening with this particular “auto-ped.” Read the rest of this entry ?

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