Posts Tagged ‘Nurses’

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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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Memorial Day Weekend: Thanks to the Nurses Who Served

May 23, 2014

By Jacob Molyneux, senior editor/blog editor

AJN wishes all of our U.S. readers (and everyone else too) a safe, restful Memorial Day weekend, whether you are driving to the shore or the hills, staying put and having a barbeque, finishing a dissertation, running a 10K, working all weekend in the emergency department, gardening, or binge-watching episodes of a TV show on Netflix (you know who you are).

And lest we forget: a heartfelt thanks to all nurses, present and past, who are or have served in the military in any capacity, in some cases losing their lives as they tried to save other lives and heal the wounded. And to their families. Read the rest of this entry ?

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Remembering Nurses Who Go Above and Beyond as Volunteers

May 14, 2014

By Shawn Kennedy, AJN editor-in-chief

A severely dehydrated patient receives iv fluids from Kari Jones, MD, as she is carried by a family member from triage to a tent at the Bercy CTC. Photo courtesy of Samaritan’s Purse.

A severely dehydrated patient receives IV fluids from Kari Jones, MD, as she is carried by a family member from triage to a tent at the Bercy CTC. Photo courtesy of Samaritan’s Purse.

So another Nurses Week winds down and many nurses have been acknowledged for the fine work they do. But I think more recognition should be given to nurses who go above and beyond their usual nursing work and volunteer to help those in dire circumstances. This month in AJN, one of the two CE articles is called “Responding to the Cholera Epidemic in Haiti.” It details the work of one organization and its nurses. Here’s the overview:

While Haiti was still recovering from the January 12, 2010, magnitude-7 earthquake, an outbreak of cholera spread throughout the nation, soon reaching epidemic proportions. Working through the faith-based nongovernmental organization Samaritan’s Purse, an NP, an epidemiologist, and a physician joined the effort to prevent the spread of disease and treat those affected. Here they describe the prevention and intervention campaigns their organization initiated, how they prepared for each, and the essential elements of their operations.

The article provides essential information about such topics as setting up cholera treatment centers, assessment, rehydration priorities, prevention, enlisting family members in monitoring fluid intake and outtake, and the use of oral antibiotics. Near the conclusion, the authors have this to say about their heightened awareness of the difference fundamental nursing care can make in such settings:

The three of us were profoundly affected by the rapid progression and overwhelming effects of cholera in people who had been well just hours earlier. Fortunately, when cholera infection is managed correctly, its resolution is as dramatic as its onset. Few diseases that are as devastating and can kill as abruptly as cholera can be so quickly and successfully managed.

 

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Hard to Resist, They Come With Health Benefits

March 28, 2014

By Shawn Kennedy, AJN editor-in-chief

ForestWe used to have a dog, a black Lab named Sam. We thought he was especially smart, though a bit of a character. He was a wonderful pet and when he died, we were heartbroken.

We didn’t want another dog right away, but it took a while to stop looking for him to greet us each time we walked in. And he wasn’t there to eat the pizza crusts or a Chinese fortune cookie (he’d sit patiently to hear one of us read his fortune to him—and yes, our kids thought we were crazy).

But as my friend Helga said, “The longer you go without a dog, the easier it is not to have one.” Eventually we got used to being in a non-pet household—we could make spur-of-the-moment decisions about going to dinner right from work or away for a weekend without a second thought of “What about Sam?” There was no need to negotiate who would do the morning walk or the evening walk when it was raining or bitterly cold out.

(How many nurses working full time have dogs, I wonder? Given the responsibilities, owning one can be a scheduling challenge, or a budget challenge for those who hire dog walkers. But then, seeing a dog at the end of the day may also be a nice change from seeing patients and colleagues, and research suggests that owning a dog is good for one’s health—petting is associated with lower blood pressure, and of course, long walks are good too.)

Read the rest of this entry ?

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Preventing Delirium, The Luxury of Time, Things We Get Right, More: Nursing Blog Roundup

March 7, 2014

By Jacob Molyneux, senior editor

Here are a few recent posts of interest at various nursing blogs:

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

In the throes of nursing school: An intriguing little pastiche of a poem (does it qualify as a ‘found word’ poem?) can be found at a newish blog, adrienne, {student} nurse, in a short post called anatomy of a bath. In another post, she makes the following observations: “In nursing school, you are not driving the train…You absolutely must keep telling yourself that there is nothing wrong with you.”

Preventing delirium in the ICU: At the INQRI blog (the blog of the Interdisciplinary Nursing Quality Research Institute), a post summarizes some recent research on implementing a “bundle” of practices to increase mobility and reduce sedation in the ICU, all in order to prevent patient delirium, which is known to have many short- and long-term negative effects.

The luxury of time. At Love and Ladybits, the author gets a tantalizing glimpse of the quality of care she’d be able to provide if she had more time to spend with each patient. Of course, this “alternative reality” can’t last, but perhaps it can serve as a touchstone of sorts during more hectic times.

The past is present. At Head Nurse, there’s a somewhat rueful post about an unexpected encounter, years later, with the author’s least favorite nursing professor (“Everybody has one of those instructors–the ones whose classes make you yearn for the sweet release of death, or at least a nice case of vascular dementia”). Read the rest of this entry ?

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NPR Syndrome

February 21, 2014

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

calligraphy, 36" x 24," mixed media on vellum, 2007,  by julianna paradisi

calligraphy, 36″ x 24,” mixed media on vellum, 2007, by julianna paradisi

Compassion fatigue is a syndrome commonly known to nurses and other professionals involved in patient care. It is the result of constant exposure to traumatic events occurring to others. Its effects on the psyche of nurses are widely studied, recognized as a factor in burnout and self-medication, and sometimes result in nurses leaving the profession.

My clinical practicum as a nursing student, nearly 30 years ago, was in oncology. There I saw patients succumb to cancer. Many were young adults. One left behind a grieving husband, and an infant. It was heartbreaking. I asked my preceptor, a skilled, compassionate, and uncannily jolly nurse, how did she avoid burnout? I did not know about compassion fatigue yet.

She wisely replied, “You need to develop a happy, fulfilling personal life outside of nursing. You have to shut it off when you leave the hospital.” It was good advice.

I took it to heart, and over the years developed a happy, fulfilling personal life. However, turning it off when leaving the hospital is more of a challenge lately. In a similar way that an opportunistic, secondary infection makes the flu lethal, the rapid influx of news by way of our digital culture is a secondary infiltration into our lives, making it difficult for sensitive souls to “shut it off” after leaving the hospital. For lack of a better term, I’ve dubbed this digital age barrage “NPR Syndrome.”

Before going further, I want to state that NPR (National Public Radio) is a respected source of news. As more and more broadcast news reports are indistinguishable from infomercials, NPR plays an important role in bringing serious news from around the world to our attention. I coined the term “NPR Syndrome” simply because I was listening to NPR when it occurred to me how challenging it is to escape compassion fatigue outside of the hospital.

The amount of suffering in the world is overwhelming to nurses.

There is not enough time to volunteer for all of the projects close to our hearts. There is not enough cash in our wallets to hand out to every homeless person we meet, or fill the shelves of food banks. There are not enough blankets to donate to shelters for the cold and displaced. Resources for brave souls traveling to developing countries to provide vaccinations and drinking water are too few. And then there are the refugees of war we see in flight every night on the evening news. It feels like we are using a Band-Aid to stop the flow of a bleeding artery.

The result is that many nurses feel guilty over having happy, fulfilled personal lives, lives that sustain us to go back to our jobs providing skilled and compassionate nursing care to our patients, where we again encounter compassion fatigue.

A lot of nurses have stopped reading, listening to, or watching the news altogether, and at over three million strong in the United States, this is a lot of political power gone to waste through being uninformed. Read the rest of this entry ?

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Take a Walk: American Heart Month, for Nurses and Everyone Else

February 3, 2014

By Shawn Kennedy, MA, RN, AJN editor-in-chief

By Eric Hunt/via Wikimedia Commons

By Eric Hunt/via Wikimedia Commons

So we all know what we need to do to prevent heart disease: eat a healthy diet (such as the highly touted Mediterranean diet, which has been “consistently effective with regard to cardiovascular risk”), get regular exercise, and don’t smoke. But most of us—and I’m guilty—don’t quite follow the advice we may give our patients or family members. It’s difficult to carve out time for oneself in addition to working all day (and for most nurses, we’re not talking a nine to five day—many work 12-hour shifts, or at least a 10-hour day if in administrative positions), plus commuting and then spending time with family. If you have school-age children in activities, there are also car pools and homework.

We need to find 30 minutes—or even 20 minutes—daily to jump-start our own engines. According to the National Heart, Lung, and Blood Institute, heart disease kills one in four women and is the leading cause of death for both women and men in the United States. And while genetics certainly plays a part, cardiovascular health is mostly about prevention. So make a 30-minute appointment with yourself and stick to it.

The American Heart Association (AHA) initiative highlighting heart disease in February is a good reminder to us all, especially in the harsh winter weather when it can be so much nicer to stay indoors. The AHA has designated Friday, February 7, as “National Wear Red Day” in order to raise awareness of heart disease in women.

I know some people who religiously go for a walk or run as soon as they get home from work. Others I know get up a half hour earlier to exercise. I walk on the treadmill while I watch the news, but rarely manage to do so every day of the week. So I forgive myself and start again. I have to—my parents and grandparents all died from heart disease and my siblings and I have other risk factors, such as hypertension or elevated cholesterol levels. Read the rest of this entry ?

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