‘Cold Calls’: Tips for Nurses When the Patient Just Got the Bad News

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

Julianna_Illustration_Cold_CallsIt’s difficult to choose which is more difficult: That moment before dialing the number of someone I’ve never met soon after they’ve received a cancer diagnosis, or the moment standing in the doorway before entering the hospital room occupied by someone I’ve also never met soon after their cancer diagnosis.

These scenarios are the health care version of a cold call. I manage them daily.

The term cold call generally refers to marketers calling someone without prior introduction with hopes of convincing them to buy their product. In the arts community, cold calling refers to an artist walking in off the street with a portfolio in the hopes of convincing a gallery owner to exhibit their art. Rarely are either appreciated.

Most nurses involved in patient care make cold calls. Walking into the room of a patient you’ve never met is a cold call. Starting an IV on someone else’s patient or in one you’ve just met is a cold call. A cold call occurs when the unconscious patient brought to the ED opens his eyes and your face is the first thing he sees.

Lots of things about nursing are difficult. For the novice and experienced alike, walking into a patient’s room after they’ve received news they or their […]

2016-11-21T13:01:20-05:00March 29th, 2016|Nursing, nursing perspective, patient engagement, Patients|0 Comments
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Medical Marijuana: A Nurse’s Primer

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

Illustration by J Paradisi. Illustration by J Paradisi.

Since I wrote “Marijuana Legalization and Potential Workplace Pitfalls for Nurses Who Partake” in July 2014, a few things have changed. For one, Measure 91 passed in Oregon, making it the third state to legalize recreational marijuana. Medical marijuana, however, has been legal since 1998 in Oregon, currently one of 23 states nationwide.

Also, when I wrote the earlier post, I was an infusion nurse—now, as an oncology nurse navigator, I’m asked about medical marijuana often, and I need to know the answers, as do all nurses practicing in states with legalized medical marijuana. Nurses working in oncology, emergency departments, pain management, infusion clinics, and pediatrics have high exposure to patients with medical marijuana cards.

By ‘knowledge,’ I don’t mean knowing everything, but knowing where to find what you need to know. In Oregon, for example, information about medical marijuana is found at the Oregon Medical Marijuana Program (OMMP). The Web site includes qualifying diagnoses, a downloadable handbook, an application packet with instructions, and a list of approved dispensaries. While retail issues surrounding recreational marijuana are still being sorted out, medical dispensaries in Oregon sell recreational marijuana to clients aged 21 and older.

Patients using medical marijuana are […]

2016-11-21T13:01:50-05:00October 27th, 2015|nursing perspective, Patients|0 Comments
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Case Studies in Effective Care Coordination by Nurses in Rural Kansas

“I did not have a clue how to proceed.”

Care coordinator Burlay Parks meets with a patient at Greeley County Health Services in Tribune, Kansas. Photo by Chrysanne Grund. Care coordinator Burlay Parks meets with a patient at Greeley County Health Services in Tribune, Kansas. Photo by Chrysanne Grund.

The opening sentence of “Pathfinding on the Frontier,” the In the Community column in the October issue of AJN, alludes to the confusion even the most organized and savvy person sometimes feels when navigating our health care system.

In rural settings, referrals to specialists from primary care providers can be difficult for patients and families to follow up on, sometimes requiring that patients travel great distances.

Patient care coordination has been shown to decrease the number of ED visits and hospitalizations. The authors of this article explore care coordination in two Kansas counties, presenting three case studies showing how a nurse care coordinator—as part of a program at a rural primary care practice funded by a two-year grant from the Robert Wood Johnson Foundation—resolved complex issues for seriously or chronically ill patients involving medications, specialists, and diagnoses. […]

2016-11-21T13:01:56-05:00October 12th, 2015|Nursing, nursing perspective, Patients|1 Comment
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Soul-Satisfied, but Heartbroken: The ‘Soft’ Skills of Oncology Nurse Navigators

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is part of a series on mountains as barriers that she is working on.

Untitled oil stick & charcoal on paper by Julianna Paradisi Untitled oil stick & charcoal on paper by Julianna Paradisi

When I introduce myself to nurses as an oncology nurse navigator, they often respond, “Oh, that’s great,” staring blankly. Sometimes, in the midst of patient care, they say, “Yeah, that’s great, but I’m really busy. Come back later.”

Nurses caring for patients are really busy—so busy that this is one of the reasons the relatively new specialty of nurse navigators exists. Another reason is that oncology care is increasingly complex, and mostly occurs in the outpatient setting where vulnerable patients must fend for themselves.

Patient navigation was founded in 1990 by Harold P. Freeman at Harlem Hospital Center to improve outcomes for poverty-stricken African-American women presenting with stage III and IV breast cancer. Freeman declared, “The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.”

In 2010, the Affordable Care Act (ACA) mandated patient navigation for oncology by 2015. No […]

2016-11-21T13:02:21-05:00June 22nd, 2015|career, Nursing, nursing perspective, Patients|0 Comments
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More Than Competencies and Checklists: The Shadow Side of Nurse Orientation

‘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 […]

2016-11-21T13:02:45-05:00March 30th, 2015|career, Nursing, nursing perspective|4 Comments
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