Archive for the ‘Social media’ Category

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Unbalanced: The Art of Changing Nursing Roles

October 1, 2014
Bull and Monkey/ graphite, charcoal, acrylic on vellum/by julianna paradisi

Bull and Monkey/graphite, charcoal, acrylic on vellum/by julianna paradisi

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

The culture shock experienced by new nurses making the transition from student to professional is well documented. Less well documented is the culture shock seasoned nurses face when changing jobs. Not all nurses are the same. Neither are all nursing jobs.

Working in an unfamiliar setting means being the new guy. You may have been in the top 10 of your nursing class for grades and clinical excellence. Or you may have held a position of leadership in your previous unit. In your new job, you are unknown and unproven.

For nurses changing jobs from high-acuity areas—ICU or bone marrow transplant, say—to an ambulatory clinic, the stress is twofold.

First, there’s a period of grieving the loss of hard-won skills and certifications that are not applicable in the new role.

Then there’s the shock that your skills and experiences did not prepare you for the outpatient setting. Often, the first realization is that high-acuity patients have central lines, so a nurse migrating from such a practice area may not have strong peripheral IV skills.

By contrast, placing peripheral IV’s is something outpatient infusion nurses do all day long; IV placement skills are learned over time through practice. The nurse experienced in high-acuity patient care is suddenly a beginner, often needing the help of coworkers to insert IV’s in patients. The inability to consistently start a peripheral IV is frustrating for the nurse and for coworkers, not to mention the patient.

I’ve been thinking a lot about how it feels to be new at a job, because of the changes at mine (see earlier post, “The ACA and Me: A Dispatch from the Trenches”). Although my job is basically the same job that it was, the oncology piece has greatly expanded, and I’ve worked hard to become familiar with numerous chemotherapy regimens. Read the rest of this entry ?

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If You Want to Write, Do It (and Skip the ‘Weaseling Qualifiers’)

September 26, 2014
Photo by mezone, via Flickr.

Photo by mezone, via Flickr.

Are you one of those people—nurse or otherwise—who daydreams about writing (a personal essay about a formative experience, an article about a quality improvement project you took part in, a blog post about some aspect of nursing) but can’t seem to find the proper way to get started?

Since the weekend is coming and the October issue of AJN is now live on our Web site, it seems a good time to draw attention to “On Writing: Just Do It,” the editorial by Shawn Kennedy, AJN‘s editor-in-chief. Kennedy points out the one idea common to most writing advice: you have to start somewhere. You have to do it, and learn from doing it, and then keep doing it. Or, as she puts it:

One key to becoming a good writer—or a good anything—is persistence.

But the editorial also gives a range of other excellent tips from Kennedy and several experts in the field, and quotes writing advice found in AJN issues through the decades. My favorite bit is from a 1977 editorial by former AJN editor Thelma Schorr:

“[the writer] will use the active voice and not shirk his [or her] responsibility by introducing a statement with such weaseling qualifiers as ‘It is considered that…’ or ‘It is generally believed that…’”

What a great word: “weaseling.” It’s about as far as you can get from the jargon that afflicts so much academic writing. So if you’ve got some free time this weekend, take 15 minutes and see what happens. Netflix will wait.—Jacob Molyneux, senior editor

 

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The Underlying Connection Is Nursing

September 22, 2014
Angel sculpture on grave marker

photo by author

Marcy Phipps, BSN, RN, CCRN, ATCN, TNCC, an ICU nurse who recently took up flight nursing, is an occasional contributor to this blog.

I recently experienced a series of events that seemed interconnected and orchestrated.

It started with my usual morning run. I was jogging out of my neighborhood, already sweating in the summer heat and absorbed—coincidentally—in an audio podcast about trauma care, when I came upon a man sprawled in the middle of a usually very busy thoroughfare. His motorcycle, badly damaged, was lying on its side next to a car with a crumpled door panel. The accident had clearly just occurred—traffic hadn’t yet backed up and no sirens could be heard heralding imminent assistance.

I had the weird sensation that I’d been running to the accident all along. I held his C-spine and monitored his neuro status while an off-duty paramedic managed the scene. Unexpectedly, a cardiologist I sometimes work with emerged from a nearby café and held his fingers to the man’s radial pulse, and then several more off-duty paramedics arrived.

It seemed fortuitous to me at the time—not the accident, of course, but the proximity of medical personnel who were so quickly available. And I had the impression that, despite not having worn a helmet, the motorcycle rider would be okay. He was talking to me, after all, and I didn’t see any obvious deformities or signs of severe injury.

About a week later, with the motorcyclist (and a shred of doubt) in the back of my mind, I glanced through the obituary section of the local paper. I should say that I almost never read the newspaper. When I do, I don’t look at the obituaries. And yet, on this rare occasion, I saw that not only had the motorcyclist succumbed to his injuries several days after his accident, but also that a patient with whom I’d developed a friendship several years ago had died, and that his memorial service was the following day. Read the rest of this entry ?

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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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Blogging: As Many Voices as There Are Nurses

August 20, 2014

By Jacob Molyneux, AJN senior editor

Blogging - What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

A recent check reveals that a good percentage of the blogs on our nursing blogs list have been relatively active over the past few months. A few have been less so. I didn’t see any posts about the ice-bucket challenge, and that’s okay. Here are a few recent and semirecent posts by nurses that might interest readers of this blog:

Hospice nursing. At Hospice Diary, a post from a few weeks back is called “Dying with Your Boots On.” An excerpt:

As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat, black leather boots and a crooked smile.  I stepped out of my car and told him for a moment I thought he was the garden scarecrow, until he tipped his hat.

Nurse-midwifery. A post on At Your Cervix: Tales of a New CNM, First Year gives a short nuts-and-bolts glimpse of the author’s daily work life as a certified nurse-midwife. Those considering this specialty may benefit from one person’s experience of the pros and cons of one workplace:

I thought (as I was taught) that I would have more autonomy in practice . . . the two physicians are truly the “bosses.” Everything needs to be run by them . . . I definitely have more autonomy in the office setting. There was a big difference in reading/learning about prenatal care and GYN care, versus doing it. I didn’t learn (or have clinical experience in) nearly enough GYN clients! I think the number of GYN clients for clinicals was only about 35.

For the ‘research-minded nurse.’ At the INQRI blog—that is, the blog of the Interdisciplinary Nursing Quality Research Initiative, which has a stated goal “to generate, disseminate and translate research to understand how nurses contribute to and can improve the quality of patient care”—you will find even-handed and brief summaries of recent nursing research on topics such as the potential for hourly nursing rounds to improve patient care.

Renewal. If you’re taking a vacation and going somewhere more peaceful this summer, sometime AJN blogger Amanda Anderson has a contemplative post, “The Place Where Noise Becomes Sound,” at her blog This Nurse Wonders. It starts like this:

Summer has finally found me. Somewhere in the long train ride west, between naps and riders and minutes of staring at passing trees, I listened.

Read the rest of this entry ?

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AJN’s August Issue: Preventing Pressure Ulcers, Strengths-Based Nursing, Medical Marijuana, More

August 1, 2014

AJN0814.Cover.OnlineAJN’s August issue is now available on our Web site. Here’s a selection of what not to miss.

Toward a new model of nursing. Despite the focus on patient-centered care, medicine continues to rely on a model that emphasizes a patient’s deficits rather than strengths. “Strengths-Based Nursing” describes a holistic approach to care in which eight core nursing values guide action, promoting empowerment, self-efficacy, and hope. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Decreasing pressure ulcer incidence. Hospital-acquired pressure ulcers take a high toll on patients, clinicians, and health care facilities. “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment” describes how one of the world’s largest and busiest cardiac hospitals implemented several quality improvement strategies that eventually reduced the percentage of patients with pressure ulcers from 6% to zero. This CE feature offers 2.8 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with the authors (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).

Read our Cultivating Quality column this month for another article on using evidence-based nursing practice to reduce the incidence of hospital-acquired pressure ulcers and promote wound healing. Read the rest of this entry ?

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AJN’s July Issue: Diabetes and Puberty, Getting Patient Input, Quality Measures, Professional Boundaries, More

June 27, 2014

AJN0714.Cover.OnlineAJN’s July issue is now available on our Web site. Here’s a selection of what not to miss.

Diabetes and puberty. On our cover this month, 17-year-old Trenton Jantzi tests his blood sugar before football practice. Trenton has type 1 diabetes and is one of a growing number of children and adolescents in the United States who have  been diagnosed with either type 1 or type 2 diabetes. The physical and psychological changes of puberty can add to the challenges of diabetes management. Nurses are well positioned to help patients and their families understand and meet these challenges.

To learn more more about the physical and behavioral changes experienced by adolescents with diabetes, see this month’s CE feature, “Diabetes and Puberty: A Glycemic Challenge,” and earn 2.6 CE credits by taking the test that follows the article. And don’t miss a podcast interview with the author, one of her adolescent patients, and the patient’s mother (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). Read the rest of this entry ?

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