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 we’re 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.

Camp Pendleton, CA - Packing returned meds into boxes during DEA's 1st National Prescription Drug Take-Back Day, 2010. Photo via Flickr Creative Commons/U.S. Pacific Fleet

Each year, vast quantities of unused medications are discarded in household garbage or flushed down toilets, and end up polluting our rivers and oceans. These products and byproducts have been found in water supplies and in fish and wildlife. 

AJN’s 2010 article “Leftover Drugs in the Water Supply: Don’t Flush Those Pills!” discusses the harmful effects of carelessly discarded medications and highlights state “take-back” programs in Delaware and Maine that were organized by nurses.

The federal government also has a “national take-back” initiative under the auspices of the U.S. Department of Justice Drug Enforcement Agency Office of Diversion Control. This Saturday, April 28, between 10am and 2pm, the agency will hold its fourth National Prescription Drug Take-Back Day, and will have collection sites around the country. (Click here to find local collection sites. Just enter your zip code.)

Last year, the program conducted collections at 5,327 sites in all 50 states and territories. In all, 188.5 tons of unwanted or expired medications were collected. 

So, talk it up with colleagues and patients and hospital employers—help protect our environment.

It was early. The sun had yet to rise, but already the ICU was filled with stark fluorescence and beeping alarms. My patient sat alone and aphasic, helpless amidst the bustle of the unit. The day stretched long ahead of us.

The circumstances of Frank’s admission were unusual. The nursing report (conveyed with a snicker) was that, while vacationing in our coastal city with his mistress, he’d slipped away and visited yet another lady friend. While engaged in an “intimate” act, he’d hit his head on the coffee table and been knocked unconscious.

The paramedic’s report backed up that version of events, but Frank’s admission CT scans of the brain weren’t consistent with head trauma. Instead, a vascular abnormality was found. He’d suffered two seizures since admission to the hospital.

by utahwildflowers/via Flickr

That’s the start of “The Love Song of Frank,” the Reflections essay in the May issue of AJN. Click on its title to read the entire essay (and, once there, perhaps click through to the PDF version for the best read). 

Those of you who know the T. S. Eliot poem “The Love Song of J. Alfred Prufrock” (beautifully spun, and a favorite of bookish adolescents for its highly quotable and world-weary take on conventional society) will recognize the irony in the title.

But the essay, by ICU nurse and regular AJN blogger Marcy Phipps, stands on its own in its sympathetic but unsentimental description of a nurse’s encounter with a man who’s reached the limits of his own brand of romanticism. Some readers may have less compassion for this man and his apparent fate than others. Either way, it’s well worth a read, and not our typical Reflections essay either, if such a thing exists.—JM, senior editor/blog editor 

AJN iPad app display

I just finished reading a report, released earlier this month from the Pew Research Center, on the rise of e-reading—whether on e-book readers like Kindles and Nooks; tablet devices like iPads; cell phones; or computers. The report details the results of surveys of nearly 3,000 adults ages 16 years and older conducted in December, 2011, and then again in February, 2012, about their reading habits.

Prior to the 2011 holiday season, approximately 17% of adults had read an e-book in the previous year, but in the post-holiday survey early the next year, following holiday gift giving, that number had jumped to 21%. While printed books still dominate (in December, 2011, 72% of Americans reported that they had read a printed book in the past 12 months), e-reading is growing more popular. And it seems that those who read e-books are spending more time reading “since the advent of e-content”: in particular, 41% of tablet owners and 35% of e-reading device owners say they are reading more now.

Format follows function. One question asked in the December 2011 survey was which format was better for a variety of reading situations. E-books scored slightly higher than print books for reading in bed (45% vs 43%), but considerably higher for reading while traveling or commuting (73% vs 19%), availability of broad selection of content (53% vs 35%), and “being able to get a book quickly” (83% vs 13%). I concur on all points. (Reading with a child and sharing books with others were notable exceptions, with traditional print books still highly favored for these activities.)

I wasn’t especially keen on getting an e-reading device, but my family gave me one as a gift. It proved itself when snowstorms left me stranded in Puerto Rico while I was on a winter vacation (see my blog post). The hotel’s paperback supply quickly became depleted. However, with my trusty Kindle, I just downloaded more reading material.

I love the portability of having scores of books at my disposal—and the option to get just about anything else I want, from newspapers to journals. Now, I take my iPad, which has a Kindle app that allows me to access books I downloaded on that device; it’s also backlit, which means I don’t have to keep a light on if I read in bed. I only take my Kindle if I plan to read on a beach, since it’s not backlit and doesn’t have any glare.

AJN now has an iPad app and many journals are developing them as well (we hope to eventually have applications to fit other e-reading devices too). I’m wondering—are many of you, our readers, reading e-books? Are you using the iPad, or do you prefer computers (used by a surprisingly high percentage of survey respondents), Kindles, Nooks, or other devices? We’d love to hear how you’re reading.