Archive for the ‘professional identity’ Category

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Revisiting Katrina’s Lessons 10 Years Out, from a Nursing Perspective

August 31, 2015

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Hurricane Katrina Hits New Orleans, August 29, 2005/ Wikimedia Commons

Hurricane Katrina Hits New Orleans, August 29, 2005/ Wikimedia Commons

This past week we’ve seen many media retrospectives on the devastation Hurricane Katrina visited on the Gulf Coast on August 29, 2005. I remember it vividly—as AJN’s news director at the time, I cut short a Labor Day vacation and flew to Mississippi on September 10 to report firsthand on how relief efforts were progressing.

I visited the emergency shelter staged at the Meridian Naval Air Station and then drove as far as I could south from Meridian toward the Gulf of Mexico. I got as far as Hattiesburg, Mississippi, before I had to turn around because there were no open gas stations and my gas tank was at half-empty. The devastation along the highway was remarkable; trees were completely flattened and debris of all sorts was scattered about as if a giant trash can had been overturned. And this was still about 70 miles inland from the Gulf.

Over the following months and then years, AJN published a number of articles and reports on health-related issues that arose from Hurricane Katrina (see the list below). We highlighted the heroics of many nurses who found ways to deliver care with few resources, discussed ethical considerations involved in some truly life-and-death decisions, monitored progress in the years following the storm, and reported on changes in disaster preparation that followed the storm. As with the 9/11 attacks, Hurricane Katrina spurred self-assessment by many groups, with politicians and spokespersons avowing that there would be changes so that such disastrous consequences would never happen again. And then, of course, there was Superstorm Sandy in 2012 . . .

Selected Coverage of Hurricane Katrina (these articles will be free until September 10)

Nurses Rising to the Occasion

“New Orleans Evacuees in Mississippi”
After Katrina, nurses help to convert a coliseum into an all-purpose clinic.

“Her Niche in Nephrology Nursing”
A dialysis nurse recognized for her efforts after Hurricane Katrina. Read the rest of this entry ?

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In a Changing Health Care Landscape, Narrowing Options for Older RNs?

August 21, 2015

Christine Contillo, RN, lives in New Jersey and has been a staff nurse at a university health service in New York City for eight years.

Fork_in_the_road_-_geograph.org.uk_-_1355424I’ve been a practicing nurse for 36 years, working continuously while raising three kids. After first trying a few other jobs, I entered nursing expecting a profession that would give me emotional fulfillment, some flexibility, and a good wage. Nursing has fit the bill for me on every level.

Throughout my career I’ve made every effort to keep advancing my skills. I’ve earned annual continuing education credits as well as attended national conferences and gained two certifications. The titles I’ve held have included supervisor, coordinator, and nurse educator. For the last eight years I’ve held a full-time position that I love in a primary care in a medical home setting. There I’ve had both an independent and a provider support role. I’m adept at use of the EHR, vaccines, triage, finding and booking specialists, travel health, patient education, removing sutures and dressing wounds, among other things.

However, I have a 3.5-hour commute each day. As I get older, my time has become much more precious. With college loans for my three kids finally paid off and my husband’s full encouragement, last year I began to look for a job closer to home.

I envisioned something similar to what I was already good at, as part of a medical team somewhere nearby. When I had worked at the hospital years ago, we used to congratulate the nurses who left for “better” jobs, in a physician’s private practice or in a nine to five clinic position. Hoping to find something like that, I began to put out my feelers.

I started by asking my own physician in a very large practice what the nurses in his office did. I was stunned by the answer. “We got rid of all our RNs,” he told me. “They were too expensive. Now we hire NPs instead of RNs and can get a lot more work out of them.” (That is, they could write prescriptions, order tests, etc.)

That’s when I realized that all the women wearing scrubs and not in lab coats in his office, the ones taking histories, drawing lab work, and documenting vital signs, were unlicensed medical assistants. What about the patient care that I had always loved, and building relationships with the patients? Where could an RN like myself still do that?

My next clue that something was amiss was a full-page glossy ad in a magazine for a plastic surgery practice. It included 12 professionally done head shots of the employees there—two handsome surgeons, two PAs, an IT specialist, a receptionist, an office manager, an insurance specialist . . . but no one who claimed RN as a credential.

Finally I ran into a retired nurse with whom I’d worked a few years earlier. She told me that she and some other retired nurses were all volunteering at a local hospital. They worked side by side with RNs on the units, not getting paid but thrilled to still be using their skills and not affecting their social security benefits. Of course, I didn’t blame them for doing what they wanted to do, but I wondered if an indirect effect of this volunteering was to help the hospital meet it’s bottom line while still being short-staffed.

After a year of talking to headhunters and following up online job posting, I was only offered hard-to-fill hospital positions. What does all of this mean for us as a profession? Read the rest of this entry ?

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Measuring a Nurse’s Career Through BLS

August 19, 2015

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

ParadisiBLSCertificationCardI was a child when I first heard the term CPR. My father, a volunteer fire captain in our community, had newly certified that day at drill. From the head of our dinner table he proclaimed, “It’s a terrible thing to have to do, but everyone should know how.”

He was right.

It feels as though I’ve known basic life support (BLS; sometimes still referred to as CPR) all my life, but I believe I was 16 years old when I first took a provider course, long before I knew I’d become a nurse.

Since then, as a former pediatric intensive care nurse, I have performed a lot of CPR, and a related professional compliment received during a pediatric resuscitation rests bittersweetly in my heart.

It was one of those codes that begins in the ED, and transfers into the PICU because survival is unlikely. The cause was cardiac. As I did compressions, and my colleague, a respiratory therapist, hand-ventilated the child, blood gases were drawn. The attending cardiologist looked over the results, and told us, “It’s too bad a perfect blood gas isn’t enough to save a life. The two of you are performing superb CPR.”

He was right. It wasn’t enough.

That was nearly 20 years ago. Basic life support recertification is required every two years. Now that I am an oncology nurse navigator, my chance of using the skill is like that of the general public. However, a current BLS card is mandatory.

Recently, I recertified. In the classroom, I reminded myself that the sequence of saving the life of the unresponsive is now circulation–airway–breathing (CAB) after decades of having been airway–breathing–circulation (ABC).

As I looked around the room, there was another change to contemplate: I was the old person in the group. As we paired off to perform the skills check, I saw the briefest flicker of disappointment in the eyes of the young ED nurse who became my partner. Her nose ring and tattoo sleeves defined our age difference. It didn’t help that I wore business casual, not scrubs. She was stuck with the old guy.

Suddenly I was that kid again, this time on the playground. The one picked last on the team. I wanted to tell her, “I used to do this as much as you do . . . I was really good at it,” but I knew this would make me sound even older.

We didn’t even tell each other our names; we just got to it. We completed our two-minute cycles, exchanging roles of first and second responder. The instructor watched in silence. “Okay you two, you’re done,” was all she said, and walked away to observe and correct the other teams, and then correct some more. Read the rest of this entry ?

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On Nursing Identity: What We Can Learn from African Nurses’ Oral Histories

August 17, 2015

 By Sylvia Foley, AJN senior editor

Port of Mauritius by Iqbal Osman, via Flickr

Port of Mauritius by Iqbal Osman, via Flickr

“I have chosen this profession and nobody can take it away from me.”—Sophie Makwangwala, study participant

In the summer of 2009, at the International Council of Nurses (ICN) Quadren­nial Congress in Durban, South Africa, a small group met to discuss collaborating on joint history projects. At that meeting, several African leaders of pro­fessional nursing associations reported that their expertise had long gone unrecognized. Seeking to have the stories of African nursing history told, they pro­posed interviews with other retired nurse leaders. Barbara Mann Wall, an American nurse researcher who was in the room that day, found herself intrigued.

The study. In keeping with Braun’s tenet that “indigenous research should be led, de­signed, controlled, and reported by indigenous peo­ple,” Wall first trained three of the African nurse leaders in the oral history method, aided by a grant from the University of Pennsylvania School of Nursing. Then the team embarked on the study reported on in this month’s original research CE, “ ‘I Am A Nurse’: Oral Histories of African Nurses.” Here’s an overview: Read the rest of this entry ?

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Patient Satisfaction and Nursing: Listening Matters, Whatever the Situation

August 7, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. Her last post on nursing and patient satisfaction surveys is here.

by runran/Flickr Creative Commons

by runran/Flickr Creative Commons

During this hospital stay, how often did nurses listen carefully to you?
1. Never
2. Sometimes
3. Usually
4. Always

Listening Carefully About Patients
“Her crit is dropping with each bowel movement, and she just won’t stop bleeding,” said my night shift colleague during the early moments of my shift.

As soon as she finished telling me the rest of my new patient’s care, I got on the phone for the ordered blood. Waiting for the first of many products to be delivered, I went to see her. As I poked around the hanging drips and fluids, checking dosages and orders, setting alarm limits, I heard my patient’s voice:

“Hello, hello? I’m so anxious. I just fell asleep for a moment and now I’ve woken up and I’m terrified. I think I need to be changed again, and I just don’t know what to do, and who are you?”

My colleague, busy with the details of resuscitation, hadn’t said much about my new patient’s anxiety. Anxiety, too often coded as neediness, is clinically important, especially in a patient with questionable stability, and doubly in a patient whose nurse must focus on speedy resuscitation more than handholding. I braced myself for what felt, just then, like an extra factor in an already challenging situation.

“Good morning,” I told her. “I’m Amanda, your nurse. I’ll be caring for you today, and my most important priority is getting blood into your body, because I’ve been told that you’re bleeding quite a bit. We want to stabilize your blood volume and stop your bleeding. We’ll do that with blood products in your IV.”

Listening Carefully To Patients
I start most of my shifts listening first, and then telling, setting a plan of care for the day together with my patients. But I didn’t like the slight bluish tint to this woman’s skin , or her heart’s steadily increasing beat. Her blood pressure was holding, but (applying Maslow’s hierarchy), I believed that she needed blood more urgently than she needed comfort (and antianxiety medication was out of the question—the resident would never agree to anything that might drop her pressure).

As I prepared to help my patient turn in the bed, she sent a million words in response: anxiety, questions, doubts of my actions and capabilities. With an eye constantly on the heart monitor, I gave the tersest of answers, my worries seemingly confirmed when I pulled back the covers and found a pool of bright blood.

Blood products came, and I pumped them into my patient’s flat veins. I was the only one in the room and I worked silently as she talked. And talked. If I had been a more experienced nurse, I would have welcomed her talking as a sign that her blood volume was sufficient enough to carry oxygen to her brain, and I would have engaged her more fully, both as a means of assessment and as a way to relieve her anxiety. But I was entirely wrapped up in the physical realm—stopping the bleeding and resuscitating the volume. Read the rest of this entry ?

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AJN in August: Oral Histories of African Nurses, Opioid Abuse, Misplaced Enteral Tubes, More

August 3, 2015

AJN0815.Cover.OnlineOn this month’s cover, a community nurse practices health education with residents of a small fishing village in rural Uganda. Former AJN clinical managing editor Karen Roush took the photo in a small community center made of dried mud bricks, wood, and straw.

According to Roush, nurses wrote the lessons out on poster-sized sheets of white paper and tacked them to the mud wall as they addressed topics like personal hygiene, sanitation, food safety, communication, and prevention of infectious diseases. The reality of nursing in Africa is explored this month in “‘I Am a Nurse’: Oral Histories of African Nurses,” original research that shares African nurse leaders’ stories so we may better understand nursing from their perspective.

Some other articles of note in the August issue:

CE feature: A major source of diverted opioid prescription medications is from friends and family members with legitimate prescriptions.  “Nurses’ Role in Preventing Prescription Opioid Diversion” describes three potential interventions in which nurses play a critical role to help prevent opioid diversion.

From our Safety Monitor column: More than 1.2 million enteral feeding tubes are placed annually in the United States. While the practice is usually safe, serious complications can occur. “Misplacements of Enteral Feeding Tubes Increase After Hospitals Switch Brands,” a report from the Pennsylvania Patient Safety Authority, reviews cases of misplaced tubes and offers guidance for how nurses can prevent such errors in their own practice.

Clinical feature: It is no surprise that physical activity comes with numerous physical and mental benefits, nor that a majority of Americans do not get enough exercise. “The Evolution of Physical Activity Promotion” updates nurses on physical activity guidelines and provides tips for encouraging patients to improve their physical activity. This feature also highlights the importance of decreasing one’s amount of sedentary and sitting time, even in physically active people. Read the rest of this entry ?

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Medicare Turns 50: Familiar Opposition in 1965, Essential and Continuing to Evolve Now

July 30, 2015
President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

On this date in 1965, exactly 50 years ago, Medicare (part of the Social Security Amendments of 1965) was signed into law by President Johnson. The debate over government-sponsored health insurance is not new, and opposition to the creation of Medicare was similar to the opposition to the Affordable Care Act and driven by many of the same organizations and arguments.

According to a timeline at SocialSecurity.gov, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article in the May 1958 issue after a health insurance bill was introduced in 1957. Yet again, one of the staunchest opponents was the AMA. In the September 1958 issue, “at the request of the American Medical Association,” AJN published an article by the AMA’s general manager explaining the AMA’s opposition. Then (as in recent years we continue to see from opponents of both Medicare and the ACA), the alternative plans proposed by the AMA and others were weak and lacked comprehensiveness. By contrast to the AMA’s position, in 1958 the American Nurses Association (ANA) formally expressed support for federal health insurance for older Americans.

Medicare continues to evolve in numerous ways, and will face unprecedented challenges in the coming years as the number of seniors continues to increase. Medicare has its flaws and waste and inefficiencies, and some of the quality measures it uses to decide compensation rates for hospitals are controversial with nurses and others. There is always room for improvement, always negotiation among competing parties, never enough money.

But some very positive news came out this week about steep reductions in Medicare patients’ mortality and hospitalization rates and in costs for hospitalized “fee-for-service” Medicare patients.

So it’s complicated, as might be expected. But where would be without Medicare? It might not be pretty.—By Shawn Kennedy, editor-in-chief, and Jacob Molyneux, senior editor

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