Archive for the ‘professional identity’ Category


Top Health Story Picks of AJN Contributing Editors for 2015

November 19, 2015

By Diane Szulecki, AJN associate editor

Kelley Johnson by Disney | ABC Television Group via Flickr

Nurse and Miss America contestant Kelley Johnson by Disney | ABC Television Group via Flickr

With the end of the year steadily approaching, AJN asked its contributing editors, editorial board members, and staff to share what they consider to be the most significant health care and nursing-related headlines of 2015 so far. Now it’s readers’ turn. See the top picks below and feel free to leave a comment to share your thoughts and additions to the list.

Clinical/Care Issues

  • The growing patient experience movement and the limitations of patient satisfaction measurements
  • The rise in chronic diseases due to lack of prevention efforts and unhealthy lifestyles
  • Substance abuse, including alcohol, prescription drugs, heroin
  • Vaccinations and issues regarding public trust of vaccines

Professional Issues

  • Nurses’ responses to critical comments made on The View and related ongoing discussion about the nursing profession’s image
  • Challenges and trends in nursing education: the shift toward advanced practice as a career path for many nurses and rapid growth in the number of DNP programs and applicants
  • Workplace stresses: staffing issues, moral distress, strain caused by an aging population with multiple comorbidities, plus an increase in the number of insured due to the Affordable Care Act

U.S Health Care and Health System Issues

  • Gun violence as a critical public health issue
  • Lack of adequate mental health care
  • Health care used as a political wedge by feuding political parties
  • Issues surrounding access to health care, including health equity and culturally sensitive care

Global Health Issues Read the rest of this entry ?


Check my Conduct: Committing to a Better Way to Act with Colleagues

November 10, 2015

Christina Purpora, PhD, RN, is an assistant professor at the University of San Francisco School of Nursing and Health Professions. She has 30 years of hospital nursing experience.

Kindness quotation. Photo by Steve Robbins/Flickr

by Steve Robbins/Flickr Creative Commons

I wonder whether any of my nurse colleagues can recall having said or done something less than kind to a peer at work. Looking back over 30 years of nursing, I am aware of times that I could have been kinder. Not too long ago, the way that Emily—a less experienced nurse who was new to our unit—conducted herself in response to my reaction to her request for help taught me that I ought to consider a better way to act.

Request for Help
I was walking out of a patient’s room when Emily greeted me by name, then said, “Ms. S has one of the new IV pumps and the alarm keeps going off. I can’t figure out what’s wrong. Can you please help me?”

I felt annoyed at her for making one more demand on my time when I could barely keep up with my current assignment. Rolling my eyes, I curtly replied, “Emily, I think you can handle it. You had the in-service like everybody else.”

Seemingly unrattled by my terse retort, Emily stood her ground. “Yes,” she told me, “I used the troubleshooting tips I learned. But there’s still a problem. I’m concerned about Ms. S. and I’m uncomfortable that I’ve missed something. I think this is a safety issue.”

I recognized Emily’s use of the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS “CUS” words: Concern, Uncomfortable, and Safety, a tool designed to clearly communicate that a patient is at risk for harm when a first attempt to get a safety threat across to a member of the health care team doesn’t work. The initial irritation I’d felt turned to embarrassment, and I answered Emily’s explanation with, “Okay, let’s go see Ms. S.”

I followed Emily to her patient’s room where, together, we figured out the problem. Ms. S. was unharmed. Outside of the patient’s room, Emily thanked me and asked what she could do for me in exchange for the time I’d spent helping her. When nothing came to mind, she reiterated, “Please let me know if something comes up, because I’d happy to help you.”

My embarrassment grew in the presence of Emily’s team approach. With the potential safety threat averted, we carried on with our respective patient care responsibilities.

Reflect and Amend
For the rest of the shift, I couldn’t stop thinking about my outburst, which stood in glaring contrast to Emily’s professionalism. When I realized that a patient could have been harmed while I was resisting my peer’s call for help, I was horrified. I wanted to apologize to Emily. Read the rest of this entry ?


The First 50 Years of NPs: An Illustrated Timeline Shows Triumphs, Continuing Practice Barriers

October 15, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

This year marks the 50th anniversary of the nurse practitioner (NP) role. Themes of innovation and sustainability emerge as one examines an illustrated timeline of the history of NPs in AJN‘s October issue and reads the accompanying text. (The first section of the timeline is below. Click to enlarge.)

Screen Shot 2015-10-14 at 1.48.08 PM

How did this advanced practice nursing role come into being? As the timeline explains, “[d]uring the 1960s, health care was becoming increasingly specialized. Physicians were moving out of general practice and into more complex and lucrative specialties, creating a void in primary care and prevention services, and in care of the chronically ill.”

To fill this void, public health nurse Loretta Ford, working with Dr. Henry Silver at the University of Colorado in 1965, launched the first NP certificate program, a seminal moment in the history of this prevention-driven, primary-care-focused nursing role.

Ford wrote about the compelling need for NPs. Calling health care a capital investment, Ford said:

“We have failed to realize the full potential of professional nurses to improve the quality of life. This group has great unused potential for bringing about health care reforms. Properly prepared and effectively utilized, nurses could advance the nation’s health in preventing illness and helping people maintain their health states, both by educating the population in self-care and by increasing access to, quality of, and equity in health services.”

While the need for the types of care NPs are uniquely prepared to provide was great, the process of standardizing practice and academic requirements has not been an easy one. The timeline outlines some important steps in standardizing academic preparation, as well as the legal and practice barriers that the profession has faced and continues to face. Read the rest of this entry ?


Nursing and Social Media’s Limits: Real Change Requires Moving Beyond Hashtags and Selfies

October 2, 2015

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

by rosmary/via Flickr

by rosmary/via Flickr

The recent #ShowMeYourStethoscope media campaign has been hailed as a powerful demonstration of the unified voice of nurses and what it can accomplish.

In case you’re not familiar with the incident that led to the outrage–after a Miss America contestant, Kelley Johnson (Miss Colorado), a registered nurse, delivered a monologue about her work for the talent portion of the yearly pageant while dressed in scrubs and wearing her stethoscope, hosts of the television show The View derided her, with one asking why she had on a “doctor’s stethoscope.”

There was soon a vigorous backlash across social media as nurses posted, blogged, and tweeted photos of themselves with stethoscopes, often adding moving descriptions of the situations where they use them or witty comments illustrating the absurdity of the hosts’ remarks.

I found it a heartening response to disrespect and ignorance. Nurses felt empowered and celebrated the opportunity to show the public what nursing is really about.

But has anything really changed? Yes, The View lost some sponsors and was forced to air an apology (albeit unconvincing and rather patronizing). And perhaps there was a brief uptick in nurses’ public image and visibility.

But does the public really now have any better idea of the complexity of nurses’ work and the richness of their contribution to health care? Will such a campaign have any impact on the issues facing the nursing profession, such as safe staffing ratios, barriers to independent advanced practice that hamper our ability to fulfill our role in primary care, or the lack of nurses in upper leadership roles in health-related organizations?

Preaching to the choir? Those of us who pay attention to social media outlets can easily get a skewed picture of the attention these viral campaigns generate. Though the incident and subsequent outrage were widely reported, particularly in entertainment and business media (because of the loss of advertisers), this alone is unlikely to create an impetus for systemic changes in health care on such issues as safe staffing ratios. Read the rest of this entry ?


The Afterlife of Trauma, Near and Far

September 28, 2015

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

Mixed media illustration by Julianna Paradisi

Mixed media illustration by Julianna Paradisi

The alarm clock rang noisily. I wasn’t ready to surrender the cozy cocoon of my bed and venture into the emotional turbulence of this particular day: The 14th anniversary of 9/11.

The week leading up to it was rough. My stepfather had quadruple coronary bypass surgery in another city. Although it was successful, and his children were there to help and support my mother, I’ve felt guilty for not being there myself, because I’m the nurse in the family, and I feel responsible for every medical problem that arises for the ones I love—even if I’m not really needed.

Besides this, at work we’re in one of those cycles where every patient gets bad news: The cancer has invaded the borders of another organ, or the patient is incredibly young for the diagnosis that’s been received. Six months into my career as an oncology nurse navigator, I realize the emotional toll from secondary trauma is often more related to a previous job as a pediatric intensive care nurse than that of my more recent position as an oncology infusion nurse.

Because of all this, I decided to minimize my media exposure to the trauma of 9/11 this year. I stayed off of Facebook, and instead of watching the morning news I listened to Lyle Lovett croon the delightfully absurd lyric, “Penguins are so sensitive to my needs.”

It almost worked, but I share an office with a colleague who lived in the New York area at the time of the attacks. When she brought up 9/11, I asked her about it; she told me her experience, and my heart broke open. Then I told her how in 2001, here in Portland, Oregon, we watched the horror on TV with the rest of the world. But I also worked in an office at a hospital, where a colleague started a flurry of emails, explaining that her friends’ son worked in Two World Trade Center and was missing. His father had seen the first tower attacked on TV. He called his son, who answered the phone from his work cubicle, unaware of the disaster outside.

“Get out of the building, it’s not safe,” his father ordered. “Get out now!” He hung up, and that was the last he’d heard from his son. My colleague’s emails asked for prayers and positive energy for her friends and their son.

Late in the afternoon, we learned that her friends’ son had called. He’d escaped before the second tower was attacked. Because of his father’s warning, he had persuaded the other people in his department to flee with him. All of them were safe.

In telling the story, the emotion from 14 years ago flooded forward, as fresh and raw as it was back then.

My colleague and I talked some more, until our words were spent. Then we went to work contacting cancer patients, helping them through their personal crises.

At the end of the day, I felt weary, empty.

On my way home, I saw a tall, thin man, more hippie than hipster, walking down the street. His stork-like gait and mid-back-length ponytail caught my eye, but it was the bouquet of flowers he carried that held my imagination. He was bringing someone flowers: a visual expression of love on this day of sorrow.

It was only a small gesture, but it reminded me why I’m a nurse.

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Reflective Writing as a Crucial Counterweight to Clinical Experience

September 25, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

Kevin V. Pxl/Flickr

Kevin V. Pxl/Flickr

When I first started working as a nurse, I didn’t write much. My shifts, twelve hours of chaos, weren’t stories to be told, just days to survive. I wrote only when, after a traumatic event surrounding a patient’s death, I felt like I didn’t know who I could talk to about it. I had always written in a journal, but I hadn’t really thought of writing as a tool for healing—I just knew that I felt better after banging on the keyboard a bit.

Other than this single instance, I didn’t make writing a regular practice during my first year of nursing—a choice I still regret. I covet all of those forgotten lessons, missed descriptors, and stories that I might use in my writing now, but mostly, I wish I had known that moving my pen on a piece of paper might’ve helped me heal from the consistent stress of my new work.

A few years ago, by then a relatively experienced ICU nurse as well as a graduate student, I took a class called, “Writing, Communication, & Healing.” Taught by a poet and health care journalist, Joy Jacobson, it came at a time when I needed to learn how to write—for me, that is. I wrote for professors and for blogs; I even scribbled in a journal before sleeping each night. But during that semester I learned—in both practical and theoretical terms—the benefits of writing for my own healing through a technique called reflective, or expressive, writing. Read the rest of this entry ?


Some Notes on Miss Colorado’s ‘I’m Just a Nurse’ Speech

September 15, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

I’m a sucker for beauty pageants. There’s something about the old-fashioned simplicity that fascinates me. While Miss America is, at its roots, a generous scholarship program, it’d be hard for me to say that I tune in for anything other than the sparkle and style.

With that said, I still love a Miss Congeniality angle, which this year’s Miss Colorado seemed to proffer in a much-praised speech. Similar to Sandra Bullock’s character, Gracie Lou Freebush, Kelley Johnson’s nurse-specific monologue was both engaging and educational. But her talent struck a little closer to home—she used the phrase “I’m just a nurse.”

Her two-minute speech won her a second-runner-up prize, as well as millions of hits online. But what did it get us nurses?

Sure, all PR for our profession is great, but the age-old, ubiquitous slur that served as the tagline for much of Ms. Johnson’s monologue makes a lot of us uneasy. Although Ms. Johnson very skillfully ended her monologue by refuting her initial proclamation, the public expression of it deserves a second look.

“Just a nurse” is not a new phrase to our profession; a brief scroll through Tumblr will do more than update the casual viewer. However, most of us steer away from association with the phrase; it discredits, it’s a conversation killer, and it has long been seen as a sarcastic way to circumvent responsibility. Shawn Kennedy, editor-in-chief of AJN, wrote back in May 2010 that nurses—regular ones—make our health care work. The phrase infuriates her, simply because it discredits the profound work we do on a day-to-day basis.

But after listening to Ms. Johnson’s speech, I wonder if we’ve been missing the opportunity behind the phrase all along. Instead of telling Joe, the patient she talks to in her monologue, “No, I’m just a nurse,” when he asked her if she could alter his medications, perhaps Nurse Johnson might have said, “You know, Joe, I can’t change your medications, because I’m a nurse. This is not a nurse’s responsibility—it’s a physician’s. But I can tell you why each one of them has been ordered, which ones might cause side effects, and how you should take them when you go home.”

In the actual speech, Kelley Johnson goes on to say, “Because I couldn’t do those things [change treatments and medications] for Joe, we connected on other levels,” and then tells of personal stories they shared. While this is a beautiful account of a nurse speaking with a patient in a human way, Johnson downplays the profound impact of her intervention—she held her patient’s hand—one that is nursing specific and should be credited with measurable improvements to both her patient’s clinical status and her hospital’s financial and performance outcomes. Read the rest of this entry ?


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