Posts Tagged ‘Nurses’

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Blogging: As Many Voices as There Are Nurses

August 20, 2014

By Jacob Molyneux, AJN senior editor

Blogging - What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

A recent check reveals that a good percentage of the blogs on our nursing blogs list have been relatively active over the past few months. A few have been less so. I didn’t see any posts about the ice-bucket challenge, and that’s okay. Here are a few recent and semirecent posts by nurses that might interest readers of this blog:

Hospice nursing. At Hospice Diary, a post from a few weeks back is called “Dying with Your Boots On.” An excerpt:

As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat, black leather boots and a crooked smile.  I stepped out of my car and told him for a moment I thought he was the garden scarecrow, until he tipped his hat.

Nurse-midwifery. A post on At Your Cervix: Tales of a New CNM, First Year gives a short nuts-and-bolts glimpse of the author’s daily work life as a certified nurse-midwife. Those considering this specialty may benefit from one person’s experience of the pros and cons of one workplace:

I thought (as I was taught) that I would have more autonomy in practice . . . the two physicians are truly the “bosses.” Everything needs to be run by them . . . I definitely have more autonomy in the office setting. There was a big difference in reading/learning about prenatal care and GYN care, versus doing it. I didn’t learn (or have clinical experience in) nearly enough GYN clients! I think the number of GYN clients for clinicals was only about 35.

For the ‘research-minded nurse.’ At the INQRI blog—that is, the blog of the Interdisciplinary Nursing Quality Research Initiative, which has a stated goal “to generate, disseminate and translate research to understand how nurses contribute to and can improve the quality of patient care”—you will find even-handed and brief summaries of recent nursing research on topics such as the potential for hourly nursing rounds to improve patient care.

Renewal. If you’re taking a vacation and going somewhere more peaceful this summer, sometime AJN blogger Amanda Anderson has a contemplative post, “The Place Where Noise Becomes Sound,” at her blog This Nurse Wonders. It starts like this:

Summer has finally found me. Somewhere in the long train ride west, between naps and riders and minutes of staring at passing trees, I listened.

Read the rest of this entry ?

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The Gaza Conflict, Through the Lens of Nursing

August 13, 2014

By Jacob Molyneux, AJN senior editor

In 2005, AJN published an article looking at the experiences of nurses in Israel and in the Palestinian territories (free until September 15; choose ‘full text’ or ‘PDF’ in upper-right of the article landing page). Here’s an excerpt:

“[N]urses in the region have many of the same problems American nurses have: disparate educational levels, struggles for professional recognition and workplace representation. The nurses I met came into the profession for diverse reasons and are working in a remarkable variety of settings, carrying on in the face of political, professional, economic, military, and personal difficulties. Yet I was amazed at the things these nurses have in common with each other—and with us. As I listened to them describe their motivations and aspirations and watched them work, the seemingly impenetrable barrier created by the ongoing military and political conflict melted away.”

Photos and captions from 2005 article about Palestinian and Israeli nurse. Courtesy of Constance Romilly.

Photos and captions from 2005 AJN article. Courtesy of Constance Romilly. Click to expand image.

The current conflict between Israel and those living in the Palestinian territories is another chapter in a long story. Our focus at AJN is not on the politics of the situation or the rhetoric of blame coming from supporters of both sides. Most of our readers already have opinions on the topic, and there are other, more appropriate places you can engage that argument.

The stress and suffering, deaths, injuries, and loss of infrastructure have been well documented. We see lots of images of bombed-out concrete buildings that seem always to have been ruins in some nameless place, with little evidence of the lives only recently played out there. Still, one at times stumbles upon photos of people caught in the shelling, the scarred, maimed, or dead lying in rows on stretchers. These are hard to look at or forget.

As has been noted by many international aid groups and the UN, the health care system in Gaza is under great strain and in urgent need of donations, with a number of hospitals destroyed and others without power or basic medical supplies. In shelters where many are seeking refuge from the bombing, the overcrowding and lack of adequate sanitation is giving rise to disease. A number of groups are mobilizing teams of surgeons and nurses to travel to Gaza and treat the wounded. Others are gathering medicines and medical supplies to send. Read the rest of this entry ?

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Marijuana Legalization and Potential Workplace Pitfalls for Nurses Who Partake

July 30, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Mount Hood, Oregon as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi

Mount Hood, Oregon, as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi

Wednesday, July 9, 2014, marked the first day of legal, recreational marijuana sales in the state of Washington, not long behind similar new laws in Colorado earlier this year. As in Colorado, the marijuana supply in Washington was initially insufficient to keep up with demand; stores ran out of cannabis before all customers waiting hours in line got through the front door.

The following weekend, my husband and I (we live in Portland, Oregon) took a road trip through the Columbia Gorge on the Washington side of the river.

“Hey, we could buy a joint here, and share it,” I joked. (Neither of us actually partakes.)

My husband, a pharmacist, remarked, “It may be legal, but testing positive at work could get either of us fired or invite state board investigation.”

For my husband and me, as Oregon residents, the point is moot: no amount of THC in our urine or blood is legal. For Washington and Colorado residents, however, the newly legalized status of marijuana creates confusion for employers and employees alike. In Washington and Colorado, a drug test positive for THC is no longer illegal, but being under the influence of legal substances like alcohol, for instance, violates employer policies.

This fact was illustrated in the news on the very first day of marijuana sales in Washington. A Spokane resident was fired when his purchase became public. Since then, the man has been rehired. After considerable media coverage, the company decided that, since he had the day off when he made the purchase, he was not under the influence while at work, the possibility of which is the underlying rationale for their drug testing policy.

Does being a nurse or health care provider add another layer of complexity to this issue? I think so. Positive drug tests are not acceptable for the majority of nurses and health care professionals. Smoking a joint legally in Washington over the weekend means that THC may remain detectable in urine for about a week, and longer for regular smokers.

You can see the dilemma: It may be legal for a nurse, pharmacist, or surgeon to smoke cannabis in Washington, or Colorado, but you probably also want to know that they are not under the influence of any mind-altering substances, legal or otherwise, during patient care. And, crucially, a positive drug level indicating intoxication has not been established for cannabis, as it has for alcohol. Read the rest of this entry ?

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VA Nursing Leadership Silent on Veterans’ Wait Times Scandal

July 9, 2014

By Gail M. Pfeifer, MA, RN, AJN news director

Audie L. Murphy Veterans Administration Hospital in San Antonio, TX / Wikimedia Commons

Audie L. Murphy Veterans Administration Hospital in San Antonio, TX / Wikimedia Commons

I’ve been trying to arrange an interview with a nurse in a leadership role at the VA’s Office of Nursing Services (ONS) for over a month now, with little success.

Granted, an excessive wait time for an interview pales in comparison with how long many veterans have had to wait for health care. Still, this has given me a tiny taste of what it must be like to enroll with the Veterans Health Administration for services: you can contact them, but you have to wait a really long time to even schedule a first appointment.

A substantive interview with AJN might have been a golden opportunity for the ONS to get out ahead of the story that has plagued the VA since the Phoenix scandal about lengthy waiting times at the VA broke in early May. (I did finally get a response of sorts. More on that below.)

To recap: The allegations in May that the Phoenix VA system had manipulated data about appointment wait times to hide the fact that veterans were not getting timely appointments galvanized public and Congressional attention.

But such problems in the VA health care system are not new, as a May 18th interim report by the VA Office of Inspector General makes clear, noting that since 2005 it has issued 18 reports on a local and national level identifying scheduling problems leading to long wait times and negative effects on veterans’ care. In 2010, the VA even established an Office of Specialty Care Transformation in the Office of Specialty Care Services to address veterans receiving “fragmented care and services, long wait times, and unaccepted [sic] delays,” according to that agency’s Website.

To be fair, it was widely reported this past week that long wait times have become “the norm” across the American health care system. Still, thousands of veterans are likely to have suffered, even in some cases died, because of the protracted wait times at Veterans Health Administration facilities.  Read the rest of this entry ?

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The Ethics of No-Smokers Hiring Policies: Examining the Assumptions

June 16, 2014
Army nurses light up in 1947. Photo courtesy of Everett Collection / Newscom.

Army nurses light up in 1947. Photo courtesy of Everett Collection / Newscom.

By Jacob Molyneux, senior editor

The Ethical Issues column in the June issue is called “The Ethics of Denying Smokers Employment in Health Care” (free until July 16). As in his previous columns, nurse–ethicist Doug Olsen models the thinking process of an ethicist, illuminating the fundamentals of ethical reasoning even as he tackles a specific ethical question.

Most positions we take on tough questions depend on a number of assumptions, both conscious and otherwise. In this article, Olsen does a great job identifying and then testing the assumptions that underlie such no-smokers hiring policies. Here are the main ones, as Olsen describes them:

  • Personal responsibility applies to smoking—that is, the individual is responsible for the smoking behavior.
  • There is a positive cost–benefit ratio in denying smokers employment.
  • Patient care is improved by not having smokers on staff.
  • Smokers can be reliably identified.
  • Smokers are not being singled out—people with other equally unhealthy behaviors meeting the criteria on this list are treated in the same way.
  • Refusing to employ smokers is good publicity for the hospital and therefore improves the hospital’s ability to fulfill its mission.

After considering the defensibility of each of these assumptions in turn, Olsen makes a distinction between what he calls “restrictive” and “caring” policies, and considers the potential effects of each on public perception when it comes to a hospital. Read the rest of this entry ?

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Addressing Health Care Disparities: Best Practices for LGBT Patients

June 9, 2014

By Sylvia Foley, AJN senior editor

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume, at a nursing care facility. Rheume suffered from Parkinson's dementia. The couple struggled to find a facility welcoming of them as a couple. Photo © Gen Silent documentary film / http://gensilent.com.

Lawrence Johnson feeds his partner of 38 years, Alexendre Rheume. Rheume suffered from Parkinson’s dementia. Photo © Gen Silent documentary film / http://gensilent.com.

It’s arguably easier these days to identify as “queer”—lesbian, gay, bisexual, or transgender (LGBT). Our society has come a long way since 1969, when the infamous Stonewall riots and other events heralded the gay rights movement. Many LGBT people can live more openly and fully as who they are. Yet this population—which constitutes an estimated 5% to 10% of the U.S. population—continues to receive often substandard health care. In this month’s CE feature, “Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: A Review of Best Practices,” Fidelindo Lim and colleagues explore these disparities and explain why it’s important for nurses in all practice settings to know how to address them. Here’s a quick overview.

The health care needs of people who are lesbian, gay, bisexual, or transgender (LGBT) have received significant attention from policymakers in the last several years. Recent reports from the Institute of Medicine, Healthy People 2020, and the Agency for Healthcare Research and Quality have all highlighted the need for such long-overdue attention. The health care disparities that affect this population are closely tied to sexual and social stigma. Furthermore, LGBT people aren’t all alike; an understanding of the various subgroups and demographic factors is vital to providing patient-centered care. This article explores LGBT health issues and health care disparities, and offers recommendations for best practices based on current evidence and standards of care.

Lim and colleagues also consider issues specific to LGBT youth and older adults, and discuss the Joint Commission’s recommendations for health care leaders. And they provide

  • a practice guide to improving cultural competence.
  • a detailed list of Web-based resources, including videos.
  • evidence-based strategies for promoting inclusive patient- and family-centered care.

For more, read the article and listen to our podcast with the lead author; both are free. We invite you to share your experiences and insights with us below.

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Writer or Nurse? The Costs of an Untold Story

June 4, 2014

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. Her blog is called This Nurse Wonders.

via Wikimedia Commons

via Wikimedia Commons

I found myself getting annoyed with a dying cancer patient today. I don’t think this is an occurrence any honest nurse would deny, but when I could feel my blood pressure rise every time she dry-heaved, I knew it’d been a mistake to come to work this morning.

Not my proudest moment.

You see, I’ve felt my nursing self change of late, with an urge growing within me to slowly step back from the bedside, at least for a bit. Perhaps it’s school and the clarification of future goals forming in my mind, but clinical work has felt more like job-work, and this other work, this future work that largely centers on telling my nursing story, is becoming what I think of as calling-work.

Staring down at my poor patient, I realized I’d swung the balance of bedside work and calling-work too much to one side lately. I’ve been working—as a nurse—too much, and working—as a writer and a student—too little. After seven years of bedside nursing, and the joys and trials of per diem work, you’d think I’d know better and respect my limit on 12-hour work.

But my wallet calls out to me in a loud voice of alarm, drowning out the subtle, more compelling but also riskier voice of my story. I knew this morning, when I responded to a call for work, that I should stay home and pick up the pen that I’d left lying motionless since finals began two weeks ago. I knew I needed a solitary day to sit and reflect, write and muse. And I knew that the unpaid hours of writing would pay off far more than the hourly rate I’d receive for my shift in the hospital. Maybe not in money just yet, but definitely in peace . . .

I followed the voice of my bills, though, and clocked in at 7 am. It wasn’t even 11 by the time I was biting my tongue and taking deep breaths in the presence of my poor patient’s agony. How could I be so incredibly insensitive to such pain? Or, to reframe my own inner query: how could I neglect my own needs, and thus compromise my ability to compassionately tend to hers? Read the rest of this entry ?

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