Posts Tagged ‘Nurses’


Workplace Bullying: One Medical Center’s Nurses Assess and Respond

February 9, 2016
photo by Ronald Keller

photo by Ronald Keller

Bullying against or by nurses has gotten a lot of attention in recent years. Aside from the suffering bullying inflicts on its victims, research tells us that bullying (which takes a number of forms, from overt insults to more subtle acts that undermine and demoralize) can also endanger patient safety and quality of care.

As described in our February article, A Task Force to Address Bullying (free access until March 1), recently a large Magnet-designated academic medical center in the Northeast developed an initiative to evaluate and address the issue at their institution. In order to first measure the problem, the task force developed a confidential online survey.

The survey had a 38% response rate. Here are some of the findings about who’s doing the bullying, who’s suffering it, and how its victims are affected by it:

 . . . . two-thirds (66%) of respondents reported having experienced or witnessed bullying in the workplace; and ‘bullies’ were most frequently identified as staff nurses (58%), followed by physicians (38%), patient care technicians (34%), and nurse managers (34%). Among the individuals who reported having been bullied, more than half experienced the following personal consequences: loss of confidence (63%), anxiety (59%), and diminished self-esteem (50%); and more than half experienced the following work consequences: decreased job satisfaction (83%), decreased teamwork and collaboration (72%), and impaired communication (63%)

When asked how they dealt with the bullying, 58% of participants said they discussed the situation with family or friends, 53% ignored the bully, 42% spoke to their nurse manager, 41% confronted the bully, and 30% considered resigning.

It’s obvious that bullying is far too common, and highly damaging in a number of ways. The task force developed a plan to address bullying, sharing the survey results with hospital staff and starting a slogan-based program called the Be Nice Champion program. Central to the plan was promotion of “third-party intervention,” not to confront the bully but to support the victim and short-circuit the isolating effects that being bullied can have. Read the rest of this entry ?


Neither Snow, Sleet, Hail, nor Major Blizzard: Business as Usual for Nurses

January 28, 2016

By Shawn Kennedy, AJN editor-in-chief

ShawnKennedyThe snowbanks in the New York area are already starting to melt, but it’s worth noting that this past weekend’s massive storm was business as usual for nurses. The New York Daily News carried a story earlier this week of a practical nurse who got a babysitter for her daughter and then walked through the height of a recent blizzard to get to her job at a nursing home.

Chantelle Diabate, who works at the Hebrew Home in Riverdale, New York, walked a mile in the snow and wind to get to work. She has been working there for six months as an LPN and said she knew they’d need her because many staff would be unable to get there. She stayed through the weekend.

by doortoriver, via Flickr

by doortoriver, via Flickr

AJN’s publisher, Anne Woods, works every Saturday as a cardiothoracic NP in a hospital near Philadelphia. With the imminent arrival of the storm on Friday afternoon, Woods went to the hospital that afternoon and spent the next 36 hours there as the only NP on duty in critical care. About 100 other staff stayed through the night, too. Woods noted that the camaraderie was uplifting, with physicians pitching in alongside nurses. Monday, Woods resumed her publishing work.

At the National Institutes of Health (NIH) in Maryland, on a pediatric bone marrow unit, the children were looking wistfully out at the falling snow of the blizzard. Given the conditions, it wasn’t safe for them to go outside, but nurses went out, filled up tubs with snow, and the young patients spent the afternoon making snowmen.
Read the rest of this entry ?


We Want You, or Someone You Know! Tell Us About Nurses Making a Difference

January 25, 2016

Uncle_Sam_(pointing_finger)Nurses in all settings are doing important work and making a difference, and we want to highlight them and the good work they do. AJN’s Profiles column highlights the diverse ways in which nurses contribute their leadership, compassion, and talent to enhance patient care directly in their institutions or through innovations in policy, research, or education that have had far-reaching impact.

Our profiles include:

We’re inviting suggestions for nurses to feature in Profiles. If you know of a nurse who is doing great work, let us know. Or if you have developed an interesting or unique program, tell us about it. Read the rest of this entry ?


Nurses and Latent TB Infection

January 18, 2016

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

Mantoux skin test/CDC PHIL

Mantoux skin test/CDC PHIL

Are you “PPD positive”?

In December, a California maternity nurse was diagnosed with active tuberculosis. More than 1,000 people, including 350 infants, may have been exposed. In infants, tuberculosis can be hard to diagnose and is more likely than in newly infected adults to progress to active disease and to disseminate to extrapulmonary sites. Therefore, a course of isoniazid was recommended for each of these exposed infants, as well as for any parents, visitors, or staff who tested positive after the exposure.

Some of the details of this incident weren’t released to the media. In my experience, active infection in a health care worker who has not recently traveled to a TB-endemic area is almost always the result of reactivated latent infection. That was the case in a similar exposure more than 10 years ago, when a New York City maternity nurse exposed more than 1,500 infants and adults to active tuberculosis.

And in three of the largest TB exposure investigations on which I’ve worked, the index cases were nurses in oncology, transplant, and the ED whose latent tuberculosis infection progressed to active infection. In these three cases, neither the RNs nor their own primary care providers connected their persistent febrile respiratory infections with their latent TB status.

A positive purified protein derivative (PPD) skin test or TB blood test isn’t simply a benign occupational hazard; it’s an important part of your medical history. For your own safety and that of your family, patients, and coworkers, this information should always be shared with personal health care providers.

While latent disease is most likely to become active within the first two years after infection, many factors can cause later activation, including immunosuppression from drugs or disease, poorly controlled diabetes, certain cancers, chronic renal failure, and malabsorption syndromes, including those precipitated by gastric bypass surgery. The likelihood of reactivation also increases with age. Read the rest of this entry ?


A Nursing Perspective on a Recent NEJM Palliative Care Article

January 8, 2016

Pam MolloyBy Pam Malloy, RN, MN, FPCN, director and co-investigator of the ELNEC Project, American Association of Colleges of Nursing (AACN), Washington, DC.

I just read a New England Journal of Medicine article by Drs. Craig D. Blinderman and the late J. Andrew Billings that came out on Christmas Eve, 2015. “Comfort Care for Patients Dying in the Hospital” was a thoughtful, informative article and I am grateful that it appeared in a journal that wasn’t focused solely on hospice/palliative care.

2016_ELNECLogoWhile the information in the article is essential for all health care professionals, I would like to take this opportunity to remind my nursing colleagues that we have a tremendous opportunity and privilege to plan, provide, and orchestrate the care that was described in this article—and we have been doing so for some time.

Nurses spend more time at the bedside and out in the community assessing and managing patients with serious, complex illness than any other health care professional. Our interdisciplinary colleagues depend on our assessments and we play a major role in developing plans of care with our diverse team. We are there having difficult conversations with patients—many times in the middle of the night when they cannot sleep.  We are entrusted with their care. It is an awesome responsibility and opportunity to care for the most vulnerable in our society, to alleviate suffering, and to provide attention to grieving families. Read the rest of this entry ?


Electronic Health Records: Still-Evolving Tools to Help or Hinder Nurses

December 14, 2015

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

Photo by Marilynn K. Yee/New York Times/Redux

Photo by Marilynn K. Yee/New York Times/Redux

One of my earliest memories of electronic health records (EHRs) is the day I had to review a chart at another hospital in the city. As I headed over to medical records, I expected at worst a “big” chart—one of those 15-inch stacks of multiple folders from a long hospitalization. I wasn’t allowed access to their system to view the chart online, so I was escorted into a separate room, in which the printed-out chart was waiting for me.

But their electronic chart wasn’t “printer-friendly,” and the hard copy version now consisted of thousands of pages of documentation spread out over a nine-foot long table. Many of the pages included only a line or two of print. Making sense of this chart was a nightmare.

My own (large, well-resourced) hospital had been one of the early adopters of an extremely clinician-friendly system, and I was shocked over the next few years when I encountered the many unwieldy, maddening charting systems that have been rushed into use at many hospitals.

In this month’s AJN, nurse and technology expert Megen Duffy gives us a clear-eyed look at the state of electronic health records today in “Nurses and the Migration to Electronic Health Records.” She is realistic about the pros and cons of electronic charting, pointing out the limitations of (for example) drop-down menus and forced choices in lieu of narrative notes, while offering a glimpse of what a well-designed system can do for us. Read the rest of this entry ?


How a Nurse Quietly Helped One Intern Out of a Tricky Situation

December 9, 2015
Illustration by Annelisa Ochoa. All rights reserved

Illustration by Annelisa Ochoa. All rights reserved

In this month’s Reflections essay, “My Turn,” a recently retired physician tells a story of how a nurse adroitly helped him through a very disorienting moment when he was still an intern. Here’s a bit of the setup:

Medicine was my first rotation as an intern. . . . [T]he medicine rotation had a particularly intimidating reputation and a red-hot I was not. I was terrified.

On morning rounds every day our entourage of physicians, nurses, and students would go room to room discussing each patient. I can still see the open door to Mrs. Finkelstein’s room near the morning sunlight at the end of the hallway. Mrs. Finkelstein was old and was dying. And every morning when we walked in, her husband was sitting there next to the bed, holding her hand. He told us regularly how many years they had been together. We each dreaded being the one on call when she died.

There are many situations in medicine and nursing that require a certain amount of experience—most readers will agree that this is definitely one of them. At a certain point in the story, the author finds himself being asked a question that absolutely needs to be answered, and answered immediately. It’s not just the intern who needs help in this moment. The stakes are high for the patient and her husband. Failure is not an option. Read the rest of this entry ?


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