Archive for the ‘professional identity’ Category


Hospital Shootings: Unacknowledged Job Hazard?

February 3, 2016

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

Active_shooter_post_illustrationRecently, while preparing for work, I received the following text from a coworker already at the hospital:

We’re on lockdown
Armed gunman
Stay home, they announced “active shooter now outside building”

Shocked, barely able to comprehend the message, I texted back:

Are you safe?

She texted back that she and others were in lockdown in the cafeteria. Numbly, I switched on the TV, looking for more information, but found nothing. Not a single report of the event on any station. Turning to the Internet, I found a single tweet referring to an event in progress. Feeling helpless, I texted my husband and daughter and then called my mom, letting them know I was at home, safe, just in case they heard something. Then I waited.

Within an hour, the same coworker texted again:

All clear!

I stared at my phone, not knowing what to do. I went to work.

The resolution of the shooting situation was heartbreaking. However, no patients or hospital staff were harmed. The outcome could have been much worse.

That evening, local media coverage of the crisis remained scant to the point I nearly felt I’d imagined it. It was as though it never happened.

We were lucky. Our shooting occurred outside, on the hospital grounds—as do 41% of hospital shootings, according to a study in the Annals of Internal Medicine. However, 59% occur inside hospitals, endangering patients and staff. Furthermore, the rate of occurrences, inside or out, is increasing.

Hospital staffs have trained for years to handle fire, child abduction, and disasters, man-made or natural. However, the realization that hospitals are soft targets, similar to schools, shopping malls, and movie theaters, dawns more slowly.

Managing a rapidly evolving and unpredictable crisis can be beyond our control. To stay and protect patients may prove impossible. Some coworkers may or may not choose to stay with their patients; you will have to decide whether or not to abandon them too. Ethical choices may come into play—I for one struggle with the concept of abandoning patients. Teachers live with this fear on a daily basis.

According to the 2015 document, Active Shooter Planning and Response in a Healthcare Setting, from the Healthcare and Public Response Sector Coordinating Council, there are a number of ways to prepare a hospital in practical terms for an active shooter situation, and also to understand the kinds of decisions that may become necessary: Read the rest of this entry ?


Rightness: A Flight Nurse Taps Into the Universal Language of Nursing

February 1, 2016

“Immersed in a nursing role that I didn’t even know existed when I entered the profession, I find there to be a common language—one rooted in science but strongest in humanity and compassion, transcending culture, geography, and words.”

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

MarcyPhipps_Flight_NursingI’m standing in the doorway of our plane, watching our patient sleep and eyeing the monitor. The monitor’s beeps keep steady time and mix with the sounds of the pounding waves that batter the atoll.

We’ve stopped for fuel on this narrow runway that stretches down a spit of land in the Pacific. As the sun rises we snack on cold gyudon, a Japanese dish we picked up in Guam. It’s not the best breakfast, but somehow feels right—like a lot of other aspects of this job lately.

We’d started our mission in eastern Asia, picking up an American citizen who’d fallen ill in a city that didn’t cater to tourists and where almost no one spoke English.

While there, our crew’s handler—someone whose job it is to facilitate our lodging, transportation, and generally ease our way—had taken us to a dimly lit restaurant on a back street and treated us to a myriad of local delicacies, some of which I recognized, many of which I didn’t. My usual morning run had led me through parks and a street market crowded with live chickens and full of fruits and vegetables I’d never seen.

But the ‘rightness’ I felt was owed entirely to the experience I had at the foreign hospital. Read the rest of this entry ?


Neither Snow, Sleet, Hail, nor Major Blizzard: Business as Usual for Nurses

January 28, 2016

By Shawn Kennedy, AJN editor-in-chief

ShawnKennedyThe snowbanks in the New York area are already starting to melt, but it’s worth noting that this past weekend’s massive storm was business as usual for nurses. The New York Daily News carried a story earlier this week of a practical nurse who got a babysitter for her daughter and then walked through the height of a recent blizzard to get to her job at a nursing home.

Chantelle Diabate, who works at the Hebrew Home in Riverdale, New York, walked a mile in the snow and wind to get to work. She has been working there for six months as an LPN and said she knew they’d need her because many staff would be unable to get there. She stayed through the weekend.

by doortoriver, via Flickr

by doortoriver, via Flickr

AJN’s publisher, Anne Woods, works every Saturday as a cardiothoracic NP in a hospital near Philadelphia. With the imminent arrival of the storm on Friday afternoon, Woods went to the hospital that afternoon and spent the next 36 hours there as the only NP on duty in critical care. About 100 other staff stayed through the night, too. Woods noted that the camaraderie was uplifting, with physicians pitching in alongside nurses. Monday, Woods resumed her publishing work.

At the National Institutes of Health (NIH) in Maryland, on a pediatric bone marrow unit, the children were looking wistfully out at the falling snow of the blizzard. Given the conditions, it wasn’t safe for them to go outside, but nurses went out, filled up tubs with snow, and the young patients spent the afternoon making snowmen.
Read the rest of this entry ?


One Nursing Wish for the New Year

January 4, 2016

By Shawn Kennedy, AJN editor-in-chief

ShawnKennedyIf there’s one universal complaint by nurses, it’s that there aren’t enough of them on a shift to provide the care their patients need. We have a lot of data linking nurse staffing to patient outcomes and revealing the deleterious effects of missed care because of insufficient staffing. Yet, according to many hospital nurses I’ve spoken with, they still find themselves stretched to the breaking point by high patient acuity, rapid patient turnover, and increasing documentation requirements.

These nurses see no end in sight to this situation as hospitals argue that they have insufficient reimbursements and revenues to increase staffing. Ironically, as hospitals invest in pricey, cutting-edge new technologies that haven’t been shown to improve patient outcomes, the evidence about nurse staffing continues to be ignored.

In November, the ANA released a white paper, “Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes.” The paper summarizes and updates the research on staffing and outcomes, linking staffing to Medicare initiatives to reduce costs, adverse events, and readmissions. The report notes:

“Existing nurse staffing systems are often antiquated and inflexible. Greater benefit can be derived from staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to account for unit and shift level factors. Factors that influence nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; and availability of or proximity to technological support or other resources.”

The report offers some specific evidence-based examples and rationales for a variety of staffing models. It’s a good review and resource for nurses who are looking to support staffing increases.

However, for me, one model—incorporating internal “float” pools—is disheartening to see. While certainly more cost-effective than outside staffing agencies, and advantageous in that the nurses are already familiar with the hospital policies and systems, this model still hearkens back to the premise that nurses are interchangeable warm bodies.

Yes, there can be some matching of skill sets—but the bottom line is that the nurse is not familiar with the patients he/she will be assigned to care for that shift. CNOs want to keep staffing lean for budget reasons, and that’s understandable. But too lean means frequent use of floaters, which may mean patients see different nurses each shift. How does that leave time for developing a nurse–patient relationship or support patient-centered care?

Read the rest of this entry ?


Evening Shift, Christmas Eve: A Nursing Memory

December 23, 2015

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

One of my fondest memories of working Christmas Eve was after an evening shift at Bellevue Hospital in New York City. This was at the “old Bellevue Hospital,” when it still occupied a series of red brick buildings along the East River.

I had finished my evening shift in the ER, which was one of the busiest in the nation. It had been a crazy–busy night and I was too wired to just go home and sleep, so I decided to stop in the chapel for midnight mass. I was surprised to see my friend Helen there, since she was Jewish. I knew Helen always volunteered to work over the Christmas holiday so those who celebrated could be with their families, but I didn’t know that after work she’d go to the chapel to listen to the Christmas music, which apparently she loved.

We sat together, enjoying the quiet, calm pace of the service and the music. Helen knew all the words and sang along; she had a beautiful voice. Staff, visitors, and some patients (wearing the classic blue-and-white-striped Bellevue bathrobes—like draw sheets, these were hard to come by) shuffled in and out during the hour, clinicians sometimes leaving hurriedly after being summoned by a beeper.

Illustration for "A Change of Heart," AJN, December, 2014, by Lisa Dietrich for AJN.

Illustration for “A Change of Heart,” AJN, December, 2014, by Lisa Dietrich

On the way out of the hospital, we popped into the ER to see how things were going—like us, that, too, had calmed down. Someone had brought in food (there was always food on holiday shifts), so after grabbing a bite to eat and visiting for a bit, commiserating about working on holidays, Helen and I went back to our apartments to sleep and get ready for the next day’s work.

It’s a memory that always stuck with me and became one of my fondest memories of Helen, who died two years ago. In our December issue last year, we published an essay, “A Change of Heart,” in our Reflections column. It dealt with a nurse’s feelings about working on Christmas yet again and being apart from her family. We’ve all been there—and we welcome you to share your memories.



Protect Yourself, Protect Your Career: Get Informed About Nurse Licensure

December 18, 2015

Edie Brous, JD, MS, MPH, RN, is a nurse and attorney in New York City and the coordinator of AJN‘s Legal Clinic column.

By Daniel X. O'Neil/via Flickr

By Daniel X. O’Neil/via Flickr

I just came back from speaking at a conference where I had the same experience I have every time I speak with nurses about licensure issues. Participants say I am telling them things they didn’t know before.

Nurses who have been in practice for decades didn’t know their state requires nursing board notification of name or address changes within a certain number of days. They didn’t know that criminal convictions, even unrelated to nursing practice, can lead to disciplinary action on their nursing licenses. They didn’t know that it is considered professional misconduct to default on child support payments. They didn’t know that discipline in one state can result in discipline in another state, even when the license in that second state is inactive or expired.

Misconceptions about state boards of nursing. Many nurses do not understand the mission of the nursing board and think that the board is supposed to be an advocate for individual nurses or for the nursing profession. In fact, the board’s mission is to protect the public. Members of the board of nursing are not there to advocate for you, but to protect the public from you when they think it is necessary.

Why are so many of us so in the dark about what it means to hold a professional license, what the nursing regulations are, and how to protect the livelihood that professional license represents? Why are nurse attorneys who practice disciplinary defense representing nurses who are in trouble simply because they didn’t know how to play by the rules? Where should we be getting that information? Who should provide it? How do we fix this?

Who could be teaching nurses about licensure? I think there is a great deal of blame to go around. In my opinion, our educators, regulators, and employers have all failed us. The information is not included in nursing school. Why not? Educators and academics don’t think it is important. Clinical education in itself is not adequate when we are preparing people for practice as licensed professionals. Students must also learn about the legal and business aspects of health care. But if we teach the material at all, we offer the information as an elective. And when it is offered, it is taught by someone with no actual experience in the legal world of representing nurses who are in trouble.

Why are schools allowed to decide to leave this critical part of our education unaddressed? Because our regulators don’t require the information to be in the curriculum for accreditation. It should not be an option. A school should not be accredited unless it actually prepares its students for the real world of professional practice. And that means the curriculum includes study of nurse practice acts and state regulations. Our regulators don’t mandate this. So schools don’t include it. So students don’t get it. So nurses don’t have the information.

Nursing boards simply issue licenses and renew them with no communication. There is no “Welcome to the practice of nursing in the state of …” letter that accompanies an initial license—a letter that would provide the nursing board’s Web site and a link to the statutes and rules, advisory opinions, practice alerts, posted disciplinary actions, and so on. A letter that would compensate in some way for the lack of information provided by the very programs the nursing board has accredited.

Our employers don’t give us the information—in addition, many of them have misunderstandings or misinformation. So we don’t get it in preparation for practice programs. We don’t get it from our regulators. We don’t get it from our employers. But we are supposed to have this information somehow. We need this information. It is no more optional than biology or pharmacology.

So here is what I recommend: Read the rest of this entry ?


Has the Future of Nursing Report Made a Difference?

December 17, 2015

Action Coalition logoBy Shawn Kennedy, AJN editor-in-chief

Last week, I went to Washington, DC, for a meeting convened to hear whether implementation of recommendations from the Institute of Medicine’s (now renamed the National Academy of Medicine, NAM) 2010 report, The Future of Nursing: Leading Change, Advancing Health, had indeed made a difference for nurses and the nursing profession.

The Robert Wood Johnson Foundation (RWJF), which sponsored the report, had also provided support to AARP’s Center to Champion Nursing in America to coordinate a “campaign for action” and manage the work of 51 state action coalitions. Five years later, RWJF asked the National Academy of Medicine to review and report on its progress.

In brief, the evaluation committee said that things were improving for nursing and that nursing needs to focus on three major themes:

  • communicating and collaborating with groups beyond nursing
  • improving diversity
  • getting better data

Read the rest of this entry ?


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