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 »


Health Technology Hazards, 2015: Alarm Issues Still Lead ECRI Top 10

January 12, 2015
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s a new year, and the ECRI Institute has released its Top 10 Health Technology Hazards for 2015 report, highlighting new health technology hazards (and some older, persistent ones) for health care facilities and nurses to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the fourth year running. But this year, the report focused on different solutions. Often, according to the report, strategies for reducing alarm hazards focus on alarm fatigue—a hazard nurses have long battled. Now, the report recommends that health care facilities examine alarm configuration policies and practices for completeness and clinical relevance. These practices include:

  • determining which alarms should be enabled.
  • selecting alarm limits to use.
  • establishing the default alarm priority level.
  • setting alarm volumes.

Repeat hazards that made the list included inadequate reprocessing of endoscopes and surgical instruments (#4), robotic surgery complications due to insufficient training (#8), and, in at #2, data integrity issues such as incorrect or missing data in electronic health records and other health IT systems. For an overview of these hazards, see our posts on ECRI top 10 health technology hazards from 2013 and 2014.

And here’s an overview of new hazards that made the cut, along with some of the report’s suggestions on how to prevent them. Read the rest of this entry »


Long-Distance Coaching

January 9, 2015

Patrice Gopo is a writer living in North Carolina.

The author

Patrice Gopo

Moments ago I’d been crouching on my bed, but now I lay wrapped in a thick duvet. My panting began to slow to a normal cadence. Then a sharp rush. My midsection hardened, followed by intense cramping. With a swift motion, I moved from lying on the bed back to all fours.

“Find your point and focus.”

I heard my mother’s words through the speakers of the computer. My eyes locked on where the edge of the metal curtain rod met the white wall.

Around me, voices and images drifted away.

Before I gave birth to my first child, I didn’t know that between a tightening abdomen and waves of pain, Skype conversations were possible.

While I appreciated that technology could bring someone distant close, my mother wasn’t supposed to be a face on the computer. She was meant to be by my side and not in a living room 10,000 miles away. But my daughter had decided to slide down the birth canal 12 days before expected.

My mother describes herself as a practical person. “I’m a nurse. It’s in the job description,” she often says. When pregnant with her own firstborn—my older sister—her contractions began in the midst of an overnight shift in the labor and delivery unit. She completed the night’s job before calling to admit herself as a patient.

Three decades later, I asked her to be with me when I gave birth for the first time. As a nurse, my mother held expert knowledge about supporting the birthing process. In her lifetime, she had helped more laboring mothers than she could remember.

“I will come early,” she’d said about flying halfway across the globe from my hometown in Anchorage, Alaska, to my married home in Cape Town, South Africa. “I’ll help you finish last-minute preparations.”

What better birth coach could there be? Probably a birth coach in the same room as me. Just before the scheduled beginning of her 36-hour journey crossing the world, she called. “They won’t let me fly. My passport is expired.”

“What? But are you still coming? When are you coming?” I paced back and forth in an attempt to slow my building anxiety.

“Not to worry. Five days. I will be there in five days,” she said in a calm voice that reflected her even temperament.

After the call ended, I threw myself on my bed and put a pillow over my head as if the slight weight might soften my distress. Hours later, my Braxton Hicks contractions escalated to something with greater force.

That night—when my mother should have been 30,000 feet above the Atlantic Ocean—I squatted on the bathroom floor, the phone cradled against my ear. After another debilitating contraction left me with a whisper in my voice, I said, “Mom, I don’t think I can do this.”

“Yes, you can.” My mother’s positive, commanding words came through the phone line. “Your body is doing exactly what it should.”

The heightened adrenaline made it difficult for my husband and me to recall and implement skills from birth class. As each contraction seized me, I couldn’t visualize any relaxing image. During the one minute that my body tensed, I wanted to—and often did—curl myself up, as I envisioned my baby folded inside of me.

“Let’s talk on Skype,” my mother suggested.

Her solution meant we could see each other. She could watch my body language for clues to my pain level and readiness. Her coaching could be more directed. Across continents, she chatted as if this were a normal day and not the middle of the night during my first, and unexpectedly early, labor.

When the next contraction began, I heard her confident, steady voice telling me to choose a single point to focus on. Just stare there. I picked where the curtain rod butted up against the wall. Read the rest of this entry »


‘Tables Turned': When the Patient’s Family Member Is a Nurse

January 7, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Illustration by Eric Collins. All rights reserved.

Illustration by Eric Collins. All rights reserved.

Nurses are not always comfortable when a patient’s family member is also a nurse. In AJN’s January Reflections essay, “The Tables Turned,” a critical care nurse describes her attempt to navigate the role change from nurse to family member when her sister is hospitalized with multiple injuries after a bike accident.

Her sister is in obvious pain, but pain management is complicated by a low blood pressure. The author asks her sister’s nurse about alternative analgesics. She writes:

“The nurse, perhaps caught off guard by my question, answered abruptly: ‘I don’t think so. We don’t do that here.’ There was a pause. ‘Don’t do what?’ I asked. ‘We don’t do IV Tylenol,’ she repeated. She did not offer an explanation, an alternative, or say she’d ask another provider… I felt helpless, both as a critical care nurse and as a sister.”

As if to reinforce that the patient’s sister is not welcome to participate in care discussions, the charge nurse soon comes by and suggests that the author “step out to get some rest.”

Of course we don’t know the nurse’s side of the story; perhaps she had already fielded questions from many families that night. In stark contrast to the situation depicted in this essay, when my friend Stella was recently hospitalized after anaphylaxis and cardiac arrest, I was kept well-informed by a terrific team of critical care nurses. They treated me like a colleague, offering detailed updates about my friend’s progress and always listening to my concerns. I felt respected and supported, both as a nurse and as Stella’s friend. Read the rest of this entry »


Are Nurses Ready for Retirement? Apparently Not

January 5, 2015

By Shawn Kennedy, AJN editor-in-chief

Photo by Judy Schmidt/CDC

Photo by Judy Schmidt/CDC

If you ask many nurses in their sixties if they’re ready to retire, they may heartily say, “Yes, can’t wait.” But if the question is whether they are financially ready to retire, the answer may be quite different.

In their article in this month’s issue of AJN, “Preparing for Retirement in Uncertain Times” (free until the end of January), authors Shanna Keele and Patricia Alpert note that surveys reveal nurses to be unsure of how to begin preparing for retirement. A 2011 survey reported that “71% felt they were not saving enough for retirement”; another survey revealed that “59% of nurses do not know how to begin the retirement planning process” and most do not feel knowledgeable about investing and other related financial processes.

Keele and Alpert, who’ve conducted research around nurses’ readiness to retire, “explore the obstacles that nurses, especially female nurses, confront in planning and preparing for retirement. We outline steps nurses can take to begin the process; discuss various types of retirement accounts; and refer readers to helpful, free online resources.” There’s also a box that lists crucial steps to take if you’re getting a late start on retirement planning. Read the rest of this entry »


AJN in January: Long-Term Complications of CHD Repair, Obesity Interventions, Nurses Planning for Retirement, More

December 29, 2014

AJN0115.Cover.OnlineAJN’s January issue is now available on our Web site. Here’s a selection of what not to miss.

Complications after cardiac repair. Nurses often encounter patients with complications that occurred years after congenital heart defect (CHD) repair. Yet many patients whose CHD was repaired in childhood have not had regular follow-up. Our CE feature, “Long-Term Outcomes After Repair of Congenital Heart Defects: Part 1,” the first in a two-part series, reviews six congenital heart defects, their repairs, and common long-term outcomes, as well as implications for nurses in both cardiac and noncardiac settings. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

To further explore the topic, listen to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes). A video of an atrial septal defect device placement is also available in the iPad edition of this article.

Obesity interventions. Patients with obesity often face stigma and bias, even from the nurses who care for them. “The Obesity Epidemic, Part 2: Nursing Assessment and Intervention,” the second article in a two-part series, presents a theoretical framework to guide nursing assessment of patients with obesity and their families and reviews the most common lifestyle, pharmacologic, and surgical interventions. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Are you ready for retirement? Nurses might be retiring later than ever, but are they planning for it? “Preparing for Retirement in Uncertain Times” shows nurses how to optimize their future financial security before leaving the workforce.

Essentials for clinical instructors.Fostering Clinical Reasoning in Nursing Students,” the third article in our Teaching for Practice series on the roles of adjunct clinical faculty and preceptors, describes the importance of developing clinical reasoning skills and how instructors can help students learn them. Read the rest of this entry »


Happy Holidays from AJN

December 23, 2014


The above image from our archives shows nurses, maybe students, at New York Hospital, early 1900s. Photo caption "Afternoon tea and midnight feasts seem to be traditional for nurses."

(The above image from our archives shows nurses, maybe students, at New York Hospital, early 1900s. Photo caption: “Afternoon tea and midnight feasts seem to be traditional for nurses.” We’ll see you in the New Year!)


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