Posts Tagged ‘Nursing’


One Nurse’s Ode to Fragility

October 7, 2015
Illustration by Lisa Dietrich for AJN.

Illustration by Lisa Dietrich for AJN.

For nurses, the world outside work may from time to time seem as fragile and tenuous as the health of patients. Natural disasters threaten homes, illnesses afflict family members, the reminders of impermanence become too insistent. This month’s Reflections essay, “The Robin,” explores such emotional terrain with sensitivity and honesty.

Gentle warning: This is not an essay that neatly delivers a pearl of take-home wisdom at the end. But that’s what we liked about it. Sometimes the best we can do is hang in there and pay close attention. And, if we’re able and willing, write about it. Here are the opening few paragraphs of this short essay: Read the rest of this entry ?


Nursing and Social Media’s Limits: Real Change Requires Moving Beyond Hashtags and Selfies

October 2, 2015

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

by rosmary/via Flickr

by rosmary/via Flickr

The recent #ShowMeYourStethoscope media campaign has been hailed as a powerful demonstration of the unified voice of nurses and what it can accomplish.

In case you’re not familiar with the incident that led to the outrage–after a Miss America contestant, Kelley Johnson (Miss Colorado), a registered nurse, delivered a monologue about her work for the talent portion of the yearly pageant while dressed in scrubs and wearing her stethoscope, hosts of the television show The View derided her, with one asking why she had on a “doctor’s stethoscope.”

There was soon a vigorous backlash across social media as nurses posted, blogged, and tweeted photos of themselves with stethoscopes, often adding moving descriptions of the situations where they use them or witty comments illustrating the absurdity of the hosts’ remarks.

I found it a heartening response to disrespect and ignorance. Nurses felt empowered and celebrated the opportunity to show the public what nursing is really about.

But has anything really changed? Yes, The View lost some sponsors and was forced to air an apology (albeit unconvincing and rather patronizing). And perhaps there was a brief uptick in nurses’ public image and visibility.

But does the public really now have any better idea of the complexity of nurses’ work and the richness of their contribution to health care? Will such a campaign have any impact on the issues facing the nursing profession, such as safe staffing ratios, barriers to independent advanced practice that hamper our ability to fulfill our role in primary care, or the lack of nurses in upper leadership roles in health-related organizations?

Preaching to the choir? Those of us who pay attention to social media outlets can easily get a skewed picture of the attention these viral campaigns generate. Though the incident and subsequent outrage were widely reported, particularly in entertainment and business media (because of the loss of advertisers), this alone is unlikely to create an impetus for systemic changes in health care on such issues as safe staffing ratios. Read the rest of this entry ?


The Afterlife of Trauma, Near and Far

September 28, 2015

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

Mixed media illustration by Julianna Paradisi

Mixed media illustration by Julianna Paradisi

The alarm clock rang noisily. I wasn’t ready to surrender the cozy cocoon of my bed and venture into the emotional turbulence of this particular day: The 14th anniversary of 9/11.

The week leading up to it was rough. My stepfather had quadruple coronary bypass surgery in another city. Although it was successful, and his children were there to help and support my mother, I’ve felt guilty for not being there myself, because I’m the nurse in the family, and I feel responsible for every medical problem that arises for the ones I love—even if I’m not really needed.

Besides this, at work we’re in one of those cycles where every patient gets bad news: The cancer has invaded the borders of another organ, or the patient is incredibly young for the diagnosis that’s been received. Six months into my career as an oncology nurse navigator, I realize the emotional toll from secondary trauma is often more related to a previous job as a pediatric intensive care nurse than that of my more recent position as an oncology infusion nurse.

Because of all this, I decided to minimize my media exposure to the trauma of 9/11 this year. I stayed off of Facebook, and instead of watching the morning news I listened to Lyle Lovett croon the delightfully absurd lyric, “Penguins are so sensitive to my needs.”

It almost worked, but I share an office with a colleague who lived in the New York area at the time of the attacks. When she brought up 9/11, I asked her about it; she told me her experience, and my heart broke open. Then I told her how in 2001, here in Portland, Oregon, we watched the horror on TV with the rest of the world. But I also worked in an office at a hospital, where a colleague started a flurry of emails, explaining that her friends’ son worked in Two World Trade Center and was missing. His father had seen the first tower attacked on TV. He called his son, who answered the phone from his work cubicle, unaware of the disaster outside.

“Get out of the building, it’s not safe,” his father ordered. “Get out now!” He hung up, and that was the last he’d heard from his son. My colleague’s emails asked for prayers and positive energy for her friends and their son.

Late in the afternoon, we learned that her friends’ son had called. He’d escaped before the second tower was attacked. Because of his father’s warning, he had persuaded the other people in his department to flee with him. All of them were safe.

In telling the story, the emotion from 14 years ago flooded forward, as fresh and raw as it was back then.

My colleague and I talked some more, until our words were spent. Then we went to work contacting cancer patients, helping them through their personal crises.

At the end of the day, I felt weary, empty.

On my way home, I saw a tall, thin man, more hippie than hipster, walking down the street. His stork-like gait and mid-back-length ponytail caught my eye, but it was the bouquet of flowers he carried that held my imagination. He was bringing someone flowers: a visual expression of love on this day of sorrow.

It was only a small gesture, but it reminded me why I’m a nurse.

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Nursing Ethics: Helping Out on the Unit vs. Teaching Nursing Students Crucial Skills

September 23, 2015

By Jacob Molyneux, AJN senior editor

scalesJust as no two hospital units are exactly alike, rarely are two ethical conflicts exactly alike. There are too many variables, too many human and situational differences. This month’s Ethical Issues column, “Teaching Crucial Knowledge vs. Helping Out on the Unit,” explores potential ethical and practical issues faced by a clinical instructor who must balance the duty to teach essential skills to nursing students against the staff’s need for help in meeting patient care needs.

Will there be an easy, cut-and-dried answer? Probably not. In the course of their analysis of a hypothetical scenario, the authors make the following point:

Because new situations arise all the time, and every situation varies in its ethically relevant aspects, rigid rules often cannot guide ethical action. Instead, analytic skills and transparent negotiation are crucial for resolving conflicts between values as they arise in day-to-day interaction—and for supporting the solutions we choose.

While people skills may be as important as abstract ethical analysis in dealing with real world situations, determining which ethical principles or priorities are coming into conflict may provide us with a certain measure of clarity in our approach. The authors frame the conflict described in the article in the following way:

Read the rest of this entry ?


Some Notes on Miss Colorado’s ‘I’m Just a Nurse’ Speech

September 15, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

I’m a sucker for beauty pageants. There’s something about the old-fashioned simplicity that fascinates me. While Miss America is, at its roots, a generous scholarship program, it’d be hard for me to say that I tune in for anything other than the sparkle and style.

With that said, I still love a Miss Congeniality angle, which this year’s Miss Colorado seemed to proffer in a much-praised speech. Similar to Sandra Bullock’s character, Gracie Lou Freebush, Kelley Johnson’s nurse-specific monologue was both engaging and educational. But her talent struck a little closer to home—she used the phrase “I’m just a nurse.”

Her two-minute speech won her a second-runner-up prize, as well as millions of hits online. But what did it get us nurses?

Sure, all PR for our profession is great, but the age-old, ubiquitous slur that served as the tagline for much of Ms. Johnson’s monologue makes a lot of us uneasy. Although Ms. Johnson very skillfully ended her monologue by refuting her initial proclamation, the public expression of it deserves a second look.

“Just a nurse” is not a new phrase to our profession; a brief scroll through Tumblr will do more than update the casual viewer. However, most of us steer away from association with the phrase; it discredits, it’s a conversation killer, and it has long been seen as a sarcastic way to circumvent responsibility. Shawn Kennedy, editor-in-chief of AJN, wrote back in May 2010 that nurses—regular ones—make our health care work. The phrase infuriates her, simply because it discredits the profound work we do on a day-to-day basis.

But after listening to Ms. Johnson’s speech, I wonder if we’ve been missing the opportunity behind the phrase all along. Instead of telling Joe, the patient she talks to in her monologue, “No, I’m just a nurse,” when he asked her if she could alter his medications, perhaps Nurse Johnson might have said, “You know, Joe, I can’t change your medications, because I’m a nurse. This is not a nurse’s responsibility—it’s a physician’s. But I can tell you why each one of them has been ordered, which ones might cause side effects, and how you should take them when you go home.”

In the actual speech, Kelley Johnson goes on to say, “Because I couldn’t do those things [change treatments and medications] for Joe, we connected on other levels,” and then tells of personal stories they shared. While this is a beautiful account of a nurse speaking with a patient in a human way, Johnson downplays the profound impact of her intervention—she held her patient’s hand—one that is nursing specific and should be credited with measurable improvements to both her patient’s clinical status and her hospital’s financial and performance outcomes. Read the rest of this entry ?


Coming Home to Nursing: A Career Change Eases a Return to a Small Town

September 8, 2015

“Working as a nurse in the county where your family has lived for seven generations has a social complexity that can’t be prepared for.”

The Reflections essay in the September issue of AJN isn’t focused on a dire clinical situation, a wrenching ethical quandary, or a challenging coworker or boss. Called “Coming Home to Nursing,” the essay describes the many ways becoming a nurse helped the author begin to feel a sense of belonging when she returned to her small town. Here’s the opening:

Illustration by Gingermoth for AJN. All rights reserved.

Illustration by Gingermoth for AJN. All rights reserved.

I had been taking care of people, in one way or another, for as long as I could remember, first growing up in Maine and then for 20 years in New York City. I had returned to my small town to help care for my mother, who had end-stage Parkinson’s disease. After she died, I felt a void. I looked around at this tiny place, where people are considered to be “from away” even if they’ve lived here for multiple generations. I wondered what I had to give back to the supportive community I’d grown up a part of—and I also wondered if I could fit in after 20 years away. Could I turn my love of taking care of people, which I had always done outside of work, and make it my profession?

Yes, the author discovers, she could—and the local hospital is the intersection that everyone or their relative passes through eventually. Read the rest of this entry ?


AJN in September: Pain Management in Opioid Use Disorder, STIs in the U.S., Teaching Vs. Unit Needs

September 2, 2015

AJN0915.Cover.OnlineOn this month’s cover, perianesthesia nurse Carolyn Benigno helps prepare a young patient for surgery at Children’s National Medical Center in Washington, DC. The photo, the first-place winner of AJN’s 2015 Faces of Caring: Nurses at Work photo contest, shows Benigno practicing “Caring through Play.” The art of working at a pediatric hospital, she says, is “learning how to play with children so that part of your nursing care is play.” Such play can both distract a child in the moment and help the child cope with the disorienting experience of hospitalization.

For another piece on how nurses try to make hospitalization less stressful for children, see this month’s Cultivating Quality article, “Improving Pediatric Temperature Measurement in the ED.”

Some other articles of note in the September issue:

CE Feature:Acute Pain Management for Inpatients with Opioid Use Disorder.” Inpatients diagnosed with opioid use disorder (OUD) commonly experience acute pain during hospitalization and may require opioids for pain management. But misconceptions about opioids and negative attitudes toward patients with OUD may lead to undermedication, unrelieved pain, and unnecessary suffering. This article reviews the current relevant literature and dispels common myths about opioids and OUD. Read the rest of this entry ?


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