This Memorial Day, we here at AJN would like to pay tribute to those nurses who gave their lives in defense of their country. And to all the nurses who care for the casualties of war with dedication, skill, and compassion, often at great risk to their own safety – we honor and thank them.

Photo by Krossbow, via Flickr

By Michael Fergenson, AJN senior editorial coordinator

Gym class. Some of us may have memories of a brusque man tossing a ball into the middle of the gym, telling us to play and occasionally blowing a whistle. Popular culture certainly portrays the “gym teacher” in this way—or worse, sometimes they’re cast as the villain. I put gym teacher in quotes in the last sentence because my dad would get angry with me if he heard that term, or “gym class” for that matter. My father considers himself a physical educator. When people call him a gym teacher, which is most of the time, he replies with the quip: “The gymnasium is the room that I teach in, but I am a physical education teacher.”

There’s something more important going on here than mere semantics. Is this pop cultural view of the gym teacher causing harm to students? I believe so.

My father has been a physical educator for a little more than 20 years. For a long time I had the same negative view of gym teachers as most people. That was until I began to study education myself. I definitely wasn’t going to be a gym teacher—oh no, it was literature for me. I would be a high school English teacher, but that didn’t sound quite right. It reminded me of my dad’s quips. I wasn’t going to teach English, I was going to teach literature. That thought stayed in the back of my mind until, for a class assignment, I went to watch my dad teach. That’s when I finally realized the difference between a gym teacher and a physical education teacher.

My dad didn’t just toss a ball and tell the kids to go play. He was teaching these kids how to be physically fit. He taught them proper nutrition, how the different muscle groups work, the types of exercises that one could do to achieve results—and that was just the beginning. He taught the difference between exercises for muscle strength, muscle endurance, and elasticity. He showed them the proper way to stretch and the proper way to cool down. In short, he was teaching his elementary school class how to be physically fit.

More importantly, he was instilling a love of his subject in his students. That is the goal of any good teacher, because it means the students will continue to learn that subject and delight it in long after they have left school.

Unfortunately, not everyone has seen real physical education. More unfortunately, those making education policy don’t seem to have either. We all know that physical education budgets are being cut around the country, because it’s seen as unnecessary. However, studies such as this one, which was recently published in the American Heart Journal, show that proper physical education can help reduce the current obesity epidemic among American children.

The Institute of Medicine (IOM) recently released the report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. According to the IOM, “Two-thirds of adults and one-third of children are overweight or obese. Left unchecked, obesity’s effects on health, health care costs, and our productivity as a nation could become catastrophic.” The report lists many recommendations for preventing obesity. One in particular, which called for “at least 60 minutes of physical activity per day,” caught my eye. Although this recommendation seems to be moving in the right direction, what constitutes “physical activity” in some schools may not be enough to get the job done.

As I learned from watching my father teach, there’s a huge difference between physical activity and physical education. Sometimes schools are forced to meet their physical activity time by just letting students out into the yard to play. This is nothing compared to actual physical education, where students learn proper exercise, nutrition, and skills to help them prevent obesity throughout their lives. This difference has to be brought to light.

The report also calls for health care providers to have an expanded role in obesity prevention, such as “routine screening of body mass index (BMI), counseling, and behavioral interventions for children.” Hopefully this post can provide nurses with new insight into this problem, and bring awareness to the difference between physical activity and physical education.

On Thursday, May 17, the New York State Nurses Association (NYSNA) held a special members-only meeting at New York City’s Jacob Javits Center to vote on bylaw changes that will drastically alter the future of the organization, morphing it from a professional association into a union. One of the key changes had to do with who could hold office in the organization: going forward, only bedside nurses, retirees, and “non-statutory” supervisors (i.e., those not able to hire or fire employees) would be eligible for office.

Other changes include eliminating the position of CEO and changing it to that of executive director, in order “to better reflect the union’s democratic roots and greater accountability to working nurses,” and a decision to push for nurse–patient staffing ratio legislation in the next session.

The NYSNA, which with 37,000 members, was founded in 1901 and is the oldest state nursing association in the country. Until January, when it was suspended for one year, it was the largest constituent member association of the ANA.

According to ANA documents, the NYSNA violated ANA bylaws by engaging in “dual unionism” when its newly elected board of directors replaced the CEO with Julie Pinkham, who is also the executive director of the Massachusetts Nurses Association (MNA). The MNA had disaffiliated from ANA in the past, along with the California Nurses Association, and were founding members of National Nurses United. The ANA maintains that this is a concerted effort to undermine NYSNA and, by affiliation, the ANA. The NYSNA appealed the decision, but the ANA reaffirmed the suspension in March. This also means that the member benefits of the 37,000 members are also suspended for the year.

I asked Bernie Mulligan, NYSNA’s communications director, about where he thought the organization’s relationship with ANA was heading. He said he felt it was premature to discuss the question of any future relationship and that the board would address that. The top priority for the organization now, he said, was getting nurse–patient ratio staffing legislation passed. “The members are clear, in that they overwhelmingly support this.”

Read more on this here.

Image via Wikimedia

Back in 2010, we ran a post by our then clinical editor, Christine Moffa. It was called “Prospects for New Nurses: Thoughts On Graduating During a Downturn” and it generated quite a few comments. Below is a sampling of excerpts. Some people were pretty distressed, wondering whether they should take jobs that separated them from their families, facing criticism from people who expected they should find a job easily. After all, they were nurses! And we all know they are always in demand.

We’ve been hearing anecdotally that the prospects for new nurses are getting better overall. Is this your experience?—JM, senior editor

“It costs a lot of money to train nurses, especially new grads. Many employers want experienced nurses. The best piece of advice given to me was to stay with same healthcare system/unit floor I worked with as a student nurse. Even that prospect, however, seems to be circling the drain for the same reason I hear over and over again: EXPERIENCE REQUIRED!!! Relocation may not be an option for some people….I’m sure I will eventually get a job, but it’s the uncertainty of my future that frustrates me. It’s quite aggravating to have worked so hard in school only to be disappointed in the end.”

“I just graduated in March and am really worried about getting a job. Thankfully I will be able to stay at my current job as a RN- I worked there as a LPN for almost a year.”

“I won’t give up; but I’m definitely discouraged. It has been a year since I graduated. I have followed all of the advice in the book – I’m volunteering, I’m looking for a job in a SNF, I network everywhere possible, I go to hospitals and shake hands with nurse managers, I follow up, I’m persistent with hiring managers to no avail. I’m desperate for some good advice regarding my circumstances and I’m not really sure where to turn.”

“No one has everything they need to be the perfect candidate, and many are far from it, because we are fallible human beings. We must keep the knowledge that we CAN do this! Someone will look at us and say, for whatever reason, that they want us. It will happen!”

“The difference between this downturn and previous year’s downturns are that there are 50% more new grads entering the market than previous years.”

“Certainly the recession is a major factor, but the lack of nursing leaders willing to demand that hospital administrators provide optimal staffing levels,is the primary problem. Only when nurses are able to provide the level of care that they have been educated to give, will retention improve. This would only be feasible with lower nurse: patient ratios. It seems that when most nurses achieve top positions in large hospitals, the staff nurse and the true quality of patient care is forgotten.”

Cycling mother and daughter, Netherlands/via Wikimedia Commons

Women, especially working women with families, often are their own last priority—the job and family come first. This week is the 13th annual National Women’s Health Week, which started on Mother’s Day, May 13, and will last until May 19th. The theme for this year is “It’s Your Time.” And it’s the perfect time for women to stop and take stock of their own health needs. This year’s Women’s Health Week is particularly poignant, coming on the tail of the recent debates about access to birth control on the national stage.

Coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health, this special week is meant to bring together health organizations, businesses, government offices, and communities in order to promote women’s health. You can find more information about how to get involved on womenshealth.gov.

Our views on women’s health continue to evolve. For example, menopause: what is a “normal” symptom during menopause? What treatments are available for various symptoms, and what can women do to help themselves? What do we currently know about the effects of certain treatments, and are they worth the possible benefits? Are we overmedicalizing women’s bodies? Or what about pregnant nurses on the job? What might endanger their health or that of their developing babies?

We’d like to offer some of our recent articles on women’s health to help increase awareness of some health issues:

“Menopausal Hormone Therapy: What We Know Now,” by AJN clinical managing editor, Karen Roush. Part I of a four-part series on postmenopausal health.

“Prevention and Treatment of Osteoporosis in Postmenopausal Women: A Review.” Part II of series.

“The Underutilization of Emergency Contraception”

“Occupational Hazards for Pregnant Nurses”

Also note part III of our ongoing series on postmenopausal health: “Managing Menopausal Symptoms.” This publish-ahead-of-print CE (available for a short time now if you click through to the PDF version, and slated to appear in the June issue of AJN), provides a useful review of the three most commonly reported symptoms of menopause: hot flashes, insomnia, and mood problems.—Michael Fergenson, senior editorial coordinator; Shawn Kennedy, editor-in-chief; Jacob Molyneux, senior editor/blog editor

Of hygiene practices at one public institution, Hobson wrote, “The visitor found a woman with a broken leg twelve days after she had been brought to the hospital in the same miserable garments in which she fell.” In describing an almshouse (poorhouse) hospital, she said, “The condition of the patients was unspeakable; the one [untrained] nurse slept in the bathroom, and the tub was filled with filthy rubbish.”

. . . On the subject of nutrition, Hobson recounted a Friday meal in the same hospital, wherein “the dinner of salt fish was brought in a bag to the ward and emptied on to the table; the convalescents helped themselves, and carried to the others their portions on a tin plate with a spoon.”

Pediatric NP, circa 1965. Courtesy of Barbara Bates Center for the Study of the History of Nursing, Univ. of Penn. School of Nursing

These are quotes from “Key Ideas in Nursing’s First Century,” an article in the May issue of AJN by historian Ellen Davidson Baer. Baer draws on vivid primary sources  from the 19th century, such as the one quoted above, to depict stages in the evolution of nursing into a respected and regulated profession with standards and essential skills and knowledge.

Though nursing has changed a great deal since its early days, Baer sees theory and compassion as intertwined constants throughout the history of nursing, both of them very much present from the start.

She’s also attuned to ways in which the evolution of nursing reveals a great deal about cultural attitudes toward gender (specifically, the roles of women), class, race, scientific knowledge, and professionalism. As you read, it’s easy to see how far nursing has come—but also how much such matters continue to play a role in the ways nurses see themselves and in how the public views nurses.—Jacob Molyneux, senior editor  

A nurse practices CPR on a voice advisory manikin. Photo courtesy of Laerdal Medical.

By Maureen Shawn Kennedy, AJN editor-in-chief

Most of you are probably aware of the AHA’s revised CPR guidelines that were issued in 2010. They include a major change in the resuscitation sequence—which now begins with chest compressions rather than ventilation—and emphasize the importance of achieving adequate compression of the chest—“at least two inches (5 cm)”—to achieve adequate blood flow. (You can see a video by the AHA demonstrating the new guidelines here.)  This change is especially important in light of recent research on CPR skills.

In 2011, Marilyn H. Oermann and colleagues conducted research with nursing students to determine how often one needs to practice CPR skills to maintain competence. 

As she explains in an article in the May issue of AJN, students who practiced briefly each month not only maintained their skills, but improved them significantly by the end of 12 months.

In comparison, the skills of those who only  had an initial training session deteriorated after three months; by 12 months, few could perform CPR adequately, especially in terms of achieving adequate depth for chest compressions. And although these were students, Oermann describes studies showing similar results with paramedics, non-ICU nurses, and nurse anesthetists. 

Most hospitals and agencies only require an annual review or demonstration of skills to be recertified in CPR; few, I bet, measure the depth of compressions. Sounds like it’s time to revisit this practice.

You can hear Oermann discuss her article in a podcast with Jo Haag, director of global training, ECC Programs, AHA, and Vanderbilt nursing professor Mary Fran Hazinski, a clinical specialist in pediatric critical care at Monroe Carell Jr. Children’s Hospital at Vanderbilt and a senior science editor at the AHA.

Image courtesy of Wikemedia Commons

Earlier this week I took care of a man who nearly coded, rather unexpectedly. I was standing next to his bed when his heart rate slowed suddenly and significantly, with one extraordinarily long pause between beats.

A pause doesn’t have to be extraordinarily long to feel like it is, especially when you’re standing next to someone, palpating their pulse while watching the monitor. In this case, in this five-second pause that felt like minutes, I’d dropped the bed rail, shouted out to my team, and was ready to start chest compressions when his heart beat again. His symptomatic bradycardia was treated accordingly; there were no chest compressions, and it was no code.

I had lunch with a good nurse-friend of mine who works in a nearby hospital. I was telling her how “bradycardia with a five-second pause” feels a lot like asystole, when you’re standing next to your patient, and she was telling me that her hospital had sort of cancelled Nurses Week this year. Instead of the traditional week of silly games, superlative awards, and physician-sponsored lunches, and then a later “Hospital Week,” her facility was having a combined “Team Member Week.”

“It feels like we’ve lost recognition,” my friend said. “We don’t feel appreciated, and we’re angry.”

I definitely see her point. Although Nurses Week festivities can seem campy sometimes, it’s the sentiment behind them that matters, and merging Nurses Week into an “everybody” celebration seems like a poor administrative move. I’m not sure I’d want to work for a hospital that didn’t specifically honor and recognize its nurses.

My friend and I agreed—whether in the case of marked bradycardia with a long pause, or in the exchange of Nurses Week for “Team Member Week,” the rhetoric doesn’t mitigate the reality, nor does it soften the reaction.

Photo from otisarchives4, via Flickr.

Many people, myself included, have mixed feelings about Nurses Week. But since many institutions have finally gotten the message that “I love nurses” shoelaces and bumper stickers are not appreciated, I’m fine with using the week to highlight nurses’ accomplishments or provide special educational programs—we should use all opportunities available to increase awareness of the value nurses bring to health care.

Former AJN editor Mary Mallison wrote an editorial for Nurses Week in 1987 that’s been deemed a classic. We’ve reprinted it in the journal, but it’s timeless in how it captures what nurses do, so here it is again (either click the above link to the article on our Web site, or just click the PDF below) for Nurses Week.

  PDF version: HowCanYouBearToBeANurse?

Photo by Michael Dorausch, via Flickr

By Michael Fergenson, senior editorial coordinator

The dangers of smoking cigarettes are well documented, from the terrifying commercials about what smoking does to our bodies to the warnings right on the pack. Yet the Centers for Disease Control and Prevention estimates that 45.3 million people in the United States smoke.

Now, a new trend in tobacco products has become the center of much debate. I’m referring to the electronic cigarettes, or e-cigarettes, that are gaining popularity as a smoking alternative and, for many, as a tool to quit.

I personally know two people who are using this device in an attempt to stop smoking. An article published in the New York Times last November reports that the number of Americans trying e-cigarettes “quadrupled from 2009 to 2010.” The article also cites the results of a survey published in Tobacco Control last year, which found that 1.2% of adults, or close to 3 million people, had reported using these products in the previous month. But are e-cigarettes really a positive smoking substitute and aid to quitting?

How they work. Most e-cigarettes are shaped like a real cigarette, but some have a unique look. They work by heating up a liquid—purchased separately from the device—until it turns into an inhalable vapor. These liquids are available in a variety of flavors, scents, and levels of nicotine content. Some have no nicotine in them at all. Even though e-cigarettes don’t emit real smoke, they can’t be used everywhere—local governments can ban their use, as can private owners of buildings or transportation services. Because these products are fairly new, there’s no way to conclusively know whether or not they are healthier than cigarettes.

Proponents say that the vapor produced is as harmless as fog-machine smoke. The liquid usually contains five to 10 ingredients, all of which are licensed for human consumption and considered safe. This is compared to the more than 5,300 ingredients that have been identified in cigarette smoke, most of which are harmful. Most people use e-cigarettes as an aid to help quit cigarettes, but some just use them as an alternative nicotine delivery system.

What the critics say. One of the arguments against e-cigarettes is that it may lead to children smoking. Since the liquid packs come in many different flavors, this may appeal to a younger demographic. It would also be easier for teenagers to hide the fact that they are using e-cigarettes, since they don’t produce the tell-tale odor of tobacco smoke. There’s also a new “smart” cigarette pack, designed for use with e-cigarettes, that sets up a social network between smokers. Also seeming to target the younger demographic, this device connects wirelessly to social networking sites, and even flashes a blue light and vibrates when it detects another smart pack nearby.

The FDA’s Web site warns against the use of e-cigarettes, stating that they may contain ingredients that are known toxins (for example, diethylene glycol, an ingredient in antifreeze) or contain small amounts of nicotine or tobacco-specific byproducts even when listed as having no nicotine. The agency also says that there have been no clinical studies evaluating the product’s safety and efficacy. An analysis of the product carried out by the FDA’s Division of Pharmaceutical Analysis tested the liquid of two leading brands and found detectable levels of carcinogens and toxic chemicals that users could be exposed to. The report also notes that there are inconsistent or nonexistant quality control processes in the manufacturing of these products. (Read the full report here.)

Further questions were raised about the product this February, when an e-cigarette exploded in a man’s mouth. The man suffered severe burns, and lost his front teeth and a chunk of his tongue. Fire officials found that this was caused by a faulty battery. (The full story can be seen here.)

Nurses can help. Only time will tell if e-cigarettes are safer than cigarettes and a viable option as an aid to quit smoking. In the meantime, nurses can help patients by being knowledgeable about these devices so they can provide accurate guidance regarding their use. By keeping up to date on e-cigarettes, nurses can offer informed advice when a smoker asks about using these devices as an aid for quitting smoking.