Archive for the ‘Social media’ Category

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More Than Competencies and Checklists: The Shadow Side of Nurse Orientation

March 30, 2015

‘Developing beneficial working relationships is part of a successful nursing orientation. If you’re lucky, your preceptor is explaining the nuances.’

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

Paradisi_Illustration_ShadowI led the first patient I had contact with as a nurse navigator to the hospital restrooms—this was her most pressing concern at the time. Building on this success, I now have a small number of patients to navigate through their cancer journeys, under advisement of my preceptors.

During this early stage, I’ve become aware that, running parallel to my orientation, a shadow orientation is also occurring.

This umbral orientation doesn’t come, like its more tangible counterpart, with a sheath of paperwork with competencies to perform or checklists to mark off. But it’s just as real. Awareness of shadow orientation develops on an intuitive level. While this experience is difficult to describe in words, it feels familiar.

Shadow orientations happen to everyone. Nearly 30 years and several nursing jobs since that first one, I’m acutely aware of the importance of a good first impression. Fortunately, this particular orientation of mine is going smoothly, but here are some observations based on past experiences.

Shadow orientation is present when you meet a staff member who makes it known this is her desk, her chair, her phone—maybe not in words, but with a look and a click of her tongue as she makes a great show of finding somewhere else to sit, despite your offer to give up the seat.

It’s happening when a physician won’t speak to you directly about your patient, instead giving his orders to the charge nurse, because you’re new. When you question it, she explains, “It takes him a long time to trust new nurses.” But she does nothing to facilitate an introduction between you.

Another example: There’s much discussion about working relationships between nurses and physicians, but little is said about the interactions between nurses and ancillary staff, such as respiratory therapists, X-ray technicians, phlebotomists, or unit secretaries. Each play important roles in patient care, but negotiating workflow can be a source of friction, depending on the individual’s level of professionalism.

I’m only partially joking when I advise striving for a good working relationship with the unit secretary. She or he knows who to call for a vacant bed, the phone and fax numbers you need, and how to make the office machines work. Even now, I can manage a patient safely on a ventilator, but am nearly helpless when the copier machine doesn’t work.

Developing beneficial working relationships is part of a successful nursing orientation. If you’re lucky, your preceptor is explaining the nuances. Read the rest of this entry ?

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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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