Archive for the ‘Social media’ Category

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Addressing Alarm Fatigue in Nursing

March 2, 2015
by flattop341/via flickr

by flattop341/via flickr

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

“Will you please silence that alarm?!” The nurse is on the phone, and can’t reach the screaming cardiac monitor. It’s a normal request, considering that we’re working together in an ICU and the alarm has been ringing for awhile.

But her request for silencing the alarm isn’t issued to me; she’s talking to the unit clerk. Stuck in my patient’s room, I watch as this untrained staff member taps the flashing rectangle on the unit’s central monitor. Without having first been appropriately evaluated, the ringing disappears, along with the words “Multifocal PVCs.”

Later, the same unit clerk absentmindedly turns off a sounding alarm, without encouragement from a nurse. I’m floating today, and although I’ve just met her, I can’t help but ask, “Do you know what that alarm was saying? Was it accurate?”

She is clearly startled by my admonishment, but I persist. “A lot of the alarms around here do seem to be false, but what if this one wasn’t? Do you have the training to know the difference, and to report it?”

If looks could kill, the one that meets my gaze is certainly homicidal, but it’s paired with a grumbled promise to never touch the screen again. So maybe my point has stuck. Read the rest of this entry ?

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Tips for Getting a Nursing Job Interview in the Age of Electronic Applications

February 26, 2015

Illustration by the author

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

Twenty-plus years ago I was job hunting in Portland, without a local connection in health care. Prepared with an Oregon nursing license, I applied for the only two open pediatric ICU positions in the city, found in newspaper want ads. The positions were in the same unit. Having several years of PICU experience, I was hopeful that I’d get an interview.

Two weeks went by without a phone call for an interview. Worse, I noticed that only one of the postings remained. With nothing to lose, I called the hospital’s human resources department.

“Hi, I applied for the positions of pediatric intensive care nurse at your hospital,” I said. “I see that one has been filled. I have seven years of experience, including transport of critically ill children, and PALS certification. I’m curious if there’s a reason I haven’t been offered an interview? I know if the manager meets me, she’ll love me.”

“I’ll look up your application, and get back to you,” was the response. Half an hour later, the PICU nurse manager called to set up an interview. “I’m sorry,” she explained. “Your application didn’t make it to my desk. Apparently it was misplaced by HR.”

I was hired at the interview, and held the position happily until transitioning to adult oncology 12 years ago.

My homespun approach may not work in today’s job market. First of all, nursing jobs are applied for online. The electronic application creates a formidable hurdle, as I learned recently while pursuing a new nursing position. If you’re really good on the phone, a follow-up call to HR might get you the phone number of the hiring manager’s office assistant, but don’t expect a return call for the voice mail you left her. It’s more likely that the HR representative will politely respond, in so many words, “Don’t call us, we’ll call you.”

Although I sought a specific position, I needed a back-up plan in case I didn’t get it, so I applied for a few others. Many experienced nurses move from job to job by calling colleagues or past managers, but most of mine had retired or moved. I was just another nurse applying electronically for a job.

If you’re a nurse looking for work, here are some ideas for getting past gatekeeping electronic applications and, hopefully, scoring an interview. Read the rest of this entry ?

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Strong Nurse and Patient Voices On the Blogs This Week

February 20, 2015

By Jacob Molyneux, senior editor/blog editor

Photo by mezone, via Flickr.

Photo by mezone, via Flickr.

Here’s a short Friday list of recent smart, honest, informative blog posts by nurses, as well as a couple of interesting patient perspectives on prominent types of chronic illness and the ways they are talked about by the rest of us.

At Head Nurse, in “Yes…No. I’m Having Some Thoughts About BSNs,” an ADN-prepared nurse makes some familiar and some more surprising observations about the effects of the new policy of hiring mostly BSN-prepared nurses at her facility as it tries for Magnet status. For example, one of the effects she notes is “a massive drop-off in terms of the diversity of our nursing staff.” The move toward BSNs is obviously the trend in nursing, and is supported by research, but this doesn’t mean that there aren’t still two sides to the issue, or real unintended consequences to address as this change is gradually implemented.

At Hospice Diary, the blog of hospice nurse Amy Getter, there’s a post called “Hearts, Flowers, and Bucket Lists.” Reflecting on the imminent death of a patient, the author puts the popular notion of bucket lists into perspective:

“I think about some of the things I would still like to do in my life, and realize . . . . most of those wish-list items would be swept away in a moment, if I only had a little time this week. I would hug my kids harder and love more, and want to squeeze every last drop of time to put into my relationships that I will have to leave behind. “

Staying with the end-of-life theme for a moment longer, you’ll find at Pallimed, a very good hospice and palliative medicine blog, a new post with a to-do list that some of us or our loved ones really can’t put off until next month or next year: “10 Practical Things to Do When Diagnosed With a Serious Illness.”

Two consistently good nurse bloggers, both of whom have written for this blog or for the journal itself from time to time, happen to have reviews of books about aspects of nursing on their blogs this week. Read the rest of this entry ?

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Enough Rants: On Fostering Meaningful Dialogue

February 4, 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.

Angry woman, Ranting

By Amancay Maahs/Flickr

“Patients are never satisfied!” “Only bedside nurses really understand nursing!” “Management always takes advantage of you!”

These are examples of the types of statements I’ve heard recently, whether talking with other nurses or reading blogs or other social media. Often presented as contributions to discussion, in reality they are rants—more interested in eliciting rote agreement than in true dialogue. This has got me thinking about how we create dialogue, especially about topics that stir an emotional response—particularly when anger is front and center. I’m a firm believer that:

  • creating dialogue is necessary and transformative
  • strong emotions are often the impetus for needed change

But we can’t allow emotions to dominate. When they do, our discussion is no longer a dialogue; it’s a rant. And rants are not productive for creating change. They eat up the energy that could otherwise be directed to positive action.

So, how do we do create dialogue about the issues that get our backs up? Here are my thoughts:

  • First, we need to separate our emotions (anger and frustration, for example) from the facts of the issue. We can present our perspective and opinion, but with a thoughtful and reasoned argument. Bracketing your feelings can be difficult, but it’s not impossible. Gathering and examining information and thinking in terms of actions can help. What is known about this issue? What do you think are the underlying factors contributing to this problem? What approaches have been tried to address them? What do you think may be worth a try? What does the research tell us? What can nurses do? What have you done to work toward resolving it?
  • Second, we need to take a good honest look at ourselves, our beliefs, and our presumptions. We need to be willing to consider other views or ways of interacting with what the world presents us. A dialogue is not one-sided, it is not didactic, and it is not finished. Real dialogue offers others a space for continued discussion. It evolves. It invokes questions. That only happens when we are open to reconsidering or modulating our views or beliefs or integrating others’ ideas with our own.
  • Third, we need to avoid generalizations. Whenever we use words like all, never, only, or always, we’re approaching rant territory. Our experience is our experience; it is not necessarily evidence of what happens in general. It can be a jumping-off point for a discussion that offers insight. But we need to put it in the context of other experiences and of what is known (the evidence) if it is to contribute to a dialogue in a meaningful way.
  • Fourth, we must be respectful of others. Stay focused on ideas and opinions and issues. Never make it personal.
  • Finally, a dialogue is not a competition to prove who is right; it is more of an exploration. When viewed as such, we can listen to others from a position of openness, rather than one of attack.

Read the rest of this entry ?

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So You’re a Nurse With a Story to Tell…

January 30, 2015

Madeleine Mysko, MA, RN, coordinator of AJN’s monthly Reflections column, is a poet, novelist, and graduate of the Johns Hopkins Writing Seminars who has taught creative writing in Baltimore for many years.

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

Whenever I meet someone new who happens to be a nurse—in both clinical and social settings—I wait for the right moment to mention my work at AJN on the Reflections column. It’s not only that I’m proud of the column. It’s also that I’m forever on the lookout for that next submission—for a fresh, compelling story I just know is destined to shine (accompanied by a fabulous professional illustration) on the inside back page of AJN.

“I imagine you have a story or two to tell,” I’ll say to a nurse I’ve just met—which is the same thing I say, whenever I have the chance, to nurses I’ve known for years. I mean it sincerely; given the vantage point on humanity that our profession affords, I actually do believe that every nurse is carrying around material for a terrific story.

The response I usually get (along with a wry smile, the raising of eyebrows, or a short laugh) is, “Oh yes. I have stories.”

But then—even as I’m mentioning the Reflections author guidelines, even as I say warmly that we’re eager to read—I can sense the backing away.

“Sure,” the nurse will say. “I’ll check it out . . . but the thing is, I’m not exactly a writer.”

Photo by mezone, via Flickr.

Photo by mezone, via Flickr.

How to explain it?—how to explain that we aren’t so much looking for nurses who are good writers as we’re looking for essays well written by good nurses.

If you’re still with me in this scenario (and especially if you’re someone not exactly inclined to sit down before breakfast on your day off and pen a gem of an essay) maybe you could let me know what you think of this pitch: Read the rest of this entry ?

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Nursing Perspective: Why I Work in Corrections

January 23, 2015

By Megen Duffy, BA, BSN, RN. Her blog is Not Nurse Ratched.

Michael Coghlan/Flickr

Michael Coghlan/Flickr

When I go to work, I go through a metal detector (did you know Danskos contain metal?), and all my belongings are scanned or gone through. I check out keys and a radio, and then I go through a series of sally ports to get to the medical area. I count every needle and pair of scissors I use. I never see patients without an armed guard nearby, and a good portion of my patients are cuffed and shackled. I’m on camera from the second I get out of my car.

Welcome to prison, nursing style!

“Why?” people ask me. “Couldn’t you get another job? Aren’t you scared? Didn’t you like the ER?” I worked in critical care/emergency nursing for a long time, and yes, I did like it. I brought those skills with me to corrections, where they are a lock-and-key fit. A surprising number of corrections nurses are ex-ER nurses. The same personality types work well in both settings.

Corrections nursing involves phenomenal nursing autonomy and uses many of the skills I honed in the ER:

  • quick triage
  • multitasking
  • sorting out who is lying from who is sick
  • knowing which assessments are the most important for each situation

The atmosphere tends to be quirky to chaotic and requires imagination, flexibility, and an ability to string together solutions to problems that no one has ever seen before. Particularly in jails, you never know what is going to come through the door. A jail booking area is exactly like ER triage.

I like that; I like having a job where strange things are bound to happen. I like seeing things that most people never see. I like knowing that things could get hairy at any time and that I have to be on my game all the time. Read the rest of this entry ?

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A Brief Meditation on Love, Loss, and Nursing

January 14, 2015

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

Manicure, by Julianna Paradisi, 2014

Manicure, by Julianna Paradisi, 2014

As a child, I remember being afraid to fall in love, because I didn’t want to experience the pain of losing people I loved when they died. I don’t know why I thought about this; I only know that I did.

Becoming a nurse has done absolutely nothing to alleviate this fear, but life experience has, to some degree.

Nursing is hard not only because we are there for the dying, but also because we are there for the illnesses and deaths of our own, the people we love, too. Making a living by caring for the sick and dying does not exempt us from personal loss. We grieve and mourn like everyone else.

Recently, I sat in a chair in an emergency department, noticing the sparkly red polish of a woman’s holiday manicure as she rolled past on a gurney. Clearly, she hadn’t anticipated an ER visit as part of her holiday celebrations either. On another gurney, next to my chair, lay my husband, getting an EKG, labs, and IV fluids. The prayer, “Please, don’t let it be a heart attack or a brain tumor,” wove silently through my thoughts.

We were lucky. There was no heart disease, no brain tumor. It was viral, just a touch of the flu. Two liters of IV normal saline did the trick.

“Thank you.”

I wish everything could be cured with a couple of liters of normal saline. There are nurses reading this post who recently grieved for loved ones absent from their places around the holiday meal table. No one mentions that all love stories eventually end. The most enduring conclude at death, and there’s the burn. Nurses know there’s no such thing as love without loss. Read the rest of this entry ?

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