Archive for the ‘professional identity’ Category

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End-of-Life Discussions and the Uneasy Role of Nurses

September 11, 2014

Amanda Anderson, BSN, RN, CCRN, is a critical care nurse in New York City and enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She is currently doing a graduate placement at AJN two days a week, working on a variety of projects. Her personal blog is called This Nurse Wonders.

Evelyn Simak/ via Wikimedia Commons

Evelyn Simak/ via Wikimedia Commons

Nurse and writer Theresa Brown wrote a piece for this past Sunday’s New York Times on the dilemmas physicians face when their patients want to stop aggressive treatment (the latest installment of Brown’s quarterly column, What I’m Reading, is in the September issue of AJN [paywall]).

Brown’s Times column talks about physicians who have trouble letting patients go and instead push for more unnecessary and often unwanted treatment. She describes a case in which—after palliative care has been decided upon by the patient’s family members, the palliative care team, and even the heartbroken oncologist—the patient’s primary care physician intervenes and pushes for still more futile treatment. (Much of the article delves into the broader issue of palliative care and the benefits it has for patients in many stages of chronic illness.)

Have you ever disagreed with a physician’s choice to continue treatments in a situation where you thought these treatments were against a patient’s real desires or best interests? Have you felt cornered in your care? What conversations did you start—or want to start but maybe felt you couldn’t?

Many times, we nurses at the bedside are afraid to speak openly with our patients about end of life, especially when physicians have different views on what should be the patient’s treatment goals. The situation feels thorny, fraught. Moral distress—when you know the right thing to do for your patient but don’t feel you have the ability to do it—can lead to burnout, high turnover rates, and many emotional stressors among nurses. Often, we simply can’t say what we want to say, despite a duty to our patients to accurately educate them on their care and conditions. Read the rest of this entry ?

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AJN’s September Issue: Anaphylaxis at School, Central Line Care, EBP, More

August 29, 2014

SeptemberAJN’s September issue is now available on our Web site. Here’s a selection of what not to miss.

It’s back-to-school time, and on our cover this month is a photo of Head Start nursing supervisor Travia Williams weighing a student in the program’s classroom at Cocoa High School in Brevard County, Florida. The program provides enrolled children with screening, physicals, and other health care services.

According to the National Association of School Nurses, a third of all school districts in the United States have reduced nursing staff and a quarter don’t have any nurses at all. Yet there is the potential for more emergencies in school now than ever, with school nurses treating increasingly complex medical conditions and chronic illnesses. For more on the important role school nurses play in handling these health emergencies, see the In Our Community article, “Emergency Anaphylaxis at School.” And don’t miss a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Applying EBP to Practice. Despite the recognized importance of evidence-based practice (EBP), there continues to be a gap between the emergence of research findings and their application to practice. In this month’s original research article, “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice,” the authors used an online survey to determine to what extent RNs in an acute care multihospital system used research findings in their practice. Several barriers to such use were revealed, including lack of time and resources. This CE feature offers 3 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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How Do You Define Nursing?

August 27, 2014

Virginia Henderson

Virginia Henderson

By Maureen Shawn Kennedy, AJN editor-in-chief

Fifty years ago this month, in the August issue of AJN, Virginia A. Henderson, one of nursing’s giants, explained how she came to her definition of nursing: “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.” (We’ve made the article, “The Nature of Nursing,” free until September 30. Click through to the PDF under “Article Tools.”)

Many (older) nurses may remember Henderson as one of the authors of Harmer and Henderson’s The Principles and Practices of Nursing, a mainstay textbook for nursing schools, or for her internationally published book, Basic Principles of Nursing Care, which was translated widely. She also taught nursing at Teacher’s College, Columbia University, and then later at Yale University, where she developed a comprehensive index of nursing research. But her accomplishments went far beyond that. Her writings helped change how nursing was being regarded—from an occupation that existed only to provide physicians with helpmates to a scholarly, independent profession.

I had the good fortune to meet Henderson in the early 1990s, when she came to AJN’s offices to meet with Fred Pattison, AJN’s librarian at the time, who was also the editor of the International Nursing Index. She was warm, engaging, down-to-earth, and had a wonderful sense of humor—not what I expected from a legend! Her personality shines through in this video, shot in 1978 for a series on nursing leaders produced by Sigma Theta Tau International.

Her biography from her 1996 induction into the American Nurses Association’s Hall of Fame notes: “A modern legend in nursing, Virginia A. Henderson has earned the title ‘foremost nurse of the 20th century.’ Her contributions are compared to those of Florence Nightingale because of their far-reaching effects on the national and international nursing communities.”

(Subscribers to AJN have full access to AJN’s complete archives, chronicling 114 years of nursing—very worthwhile browsing!)

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Coincidental Violence Against a Nurse: More Prepared Than You Think?

August 25, 2014

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

The Myth of Closure/ oil stick and charcoal on paper 2014/ Julianna Paradisi

The Myth of Closure/ oil stick and charcoal on paper 2014/ Julianna Paradisi

Recently I was attacked by a stranger while running in the bright, mid-morning sunlight of summer through a populated urban setting.

My attacker did not know I am a nurse, so it’s only coincidental that it was violence against a nurse. However, I believe my nurse’s training contributed to choices I made in response.

How It Began: As I was running towards home through a busy recreational area along the river, a disheveled man on a bicycle turned a corner from the opposite direction and I swerved left to avoid collision. I thought nothing of it, and continued on.

First Contact: A few yards later, the same man rode closely up alongside of me so suddenly that I was startled when he angrily yelled something in gibberish. My nurse’s education and experience had schooled me not to react, not to make eye contact, and to get out of his personal space. At this point, the sidewalk forked. The stranger continued towards the left. I went right, on the greenway along the river. I kept running to put distance between us.

Second Contact: I felt him coming after me on his bicycle. I knew he was going to run me down. The nurse’s ability to critically think after a rapid assessment came to my aid. To the right was the river embankment lined with rocks. It wasn’t a long fall, but the loose rocks and the river held potential for further harm if he pursued. Instead, I chose to cross left, and then make my way up and through the landscaping of the riverfront condominiums. I didn’t succeed: he hit me from behind with his bike, yelling “Run faster!”

I knew it was important to stay on my feet, and throwing my weight backwards to stop the momentum, I did—grateful for an exercise class I’d started several weeks ago, strengthening my core. Read the rest of this entry ?

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Essentials for New Clinical Nursing Instructors, Especially Adjuncts

August 22, 2014

There are many things it’s helpful to know when you start work as a clinical instructor—and you might not get a lot of orientation first.

By Maureen Shawn Kennedy, AJN editor-in-chief

“So you’ve accepted the contract for your first part-time clinical teaching assignment and you’re wondering where to start in preparing for this new role. Perhaps you’ve been working in an administrative role, away from direct caregiving. Maybe you’ve been active in bedside nursing but have no formal preparation in clinical teaching. If you take the time to prepare for your teaching assignment, you can confidently lead your students through a meaningful clinical experience.”

Clinical instructor Betsy Moorhouse (second from right) reviews the contents of a pediatric code cart with her nursing students at Miles Memorial Hospital in Damariscotta, Maine. Photo © Getty Images.

Clinical instructor Betsy Moorhouse (second from right) reviews the contents of a pediatric code cart with her nursing students at
Miles Memorial Hospital in Damariscotta, Maine. Photo © Getty Images.

So begins “Starting a Job as an Adjunct Clinical Instructor,” the second article in our quarterly column, Teaching for Practice (published in AJN‘s August issue, the article is free until the end of September).

When I was working as a clinical nurse specialist, I was also adjunct faculty for a local school of nursing, working with students in the acute care setting. Fortunately, I had taken an education minor in graduate school—otherwise, I would have felt lost when faced with setting objectives, planning pre- and postclinical conferences, and student evaluations. Read the rest of this entry ?

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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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