Posts Tagged ‘Nursing’

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The Best Nurses Day Gift: Enough Time With Patients

May 22, 2013
What's Left Behind, oil, graphite, and mixed media on wood panel. 18" by 18." Copyright J. Paradisi.

What’s Left Behind, oil, graphite, and mixed media on wood panel. 18″ by 18.” Copyright J. Paradisi.

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

I can’t remember which handle on Twitter asked nurses last week for their stories about the best or worst Nurses Day gifts from their employers, so I will tell mine here. It began badly, but became the best.

Nurses Day in May is a cute little rhyme. In Oregon, where I live, May also brings hay fever allergy, which is neither cute nor rhymes, but like Nurses Day, is an annual event.

I woke up on the morning of Nurses Day with a headache and my voice hoarse from allergy. Previously, I had traded shifts to work this day in place of another nurse with an acutely hospitalized family member. If she and I were playing Rock, Paper, Scissors, her need was scissors to my paper.

Calling in sick was not an option. It’s part of the unwritten Nurse’s Code, which is really more of a guideline, but don’t test it. Calling in sick after agreeing to work for a coworker will not garner sympathy from your unit.

When I arrived for work, another nurse remarked that my hoarse voice sounded sexy, like actress Kathleen Turner’s. Despite my crankiness from inadequate respiratory gas exchange, that cheered me up, a little.

Then The Miracle occurred:

The hospital’s phone system, including our outpatient unit’s, went down. No phone calls came in or out, not even between departments. Overhead via the PA system, the hospital operator announced over and over instructions for summoning the rapid response or code teams, if needed. Non-emergent communications were sent by e-mail, or pneumatic tube system.

It took a little while to understand that, for our outpatient clinic, what felt like calamity was in fact a surprising gift: our scheduled appointments were all that we had that shift. Offices could not call to schedule new appointments that morning. The phones at the nurse’s desk were silent.

This created a leisurely pace for our shift, which I put to work at my patients’ bedside. My allergy symptoms reminded me how it feels to be sick, replacing crankiness with compassion. For each patient I pulled up the rolly stool and sat down, listening to their stories and concerns without time pressure or ringing phones. I had time to look up information, print handouts, and answer their questions the way I was taught to do in nursing school. In short, because the phones were down, I spent Nurses Day, well, nursing. I felt fully engaged in the work, and remembered why I chose this noble profession.

By noon, the phones were back up. My headache and hoarse voice were gone. I realized I was having a great day.

Later, while I was fetching a cup of water from the water cooler for a patient to swallow pre-meds, our manger stopped by. “Hey you, how’s your Nurses Day?” he asked, affably.

“Great!” I replied. “The phones were down the first half of the shift.”

Not missing a beat with his quick wit, he winked and said, “Oh yeah. I arranged that as a gift. Have a Happy Nurses Day.”

And I did.

Disclaimer:  No patients were harmed in the making of this post.

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Winding Down Nurses Week 2013

May 10, 2013

By Shawn Kennedy, AJN editor-in-chief

We’d be remiss not to mention Florence Nightingale during Nurses Week, especially since her birthday marks the end of the celebration. (She was born on May 12, 1820.) I often wonder what this visionary would be like if she were a nurse today—my bet is she would be a PhD and FAAN, and conducting multinational outcomes research related to nursing-sensitive indicators with grants from the Royal College of Nursing and the AARP/Robert Wood Johnson Foundation’s Campaign for Nursing!

Nightingale never wrote for AJN, but there are some 200 stories and mentions of her in our archives. We thought we’d mark the close of Nurses Week with a comment from AJN’s founding editor, Sophia Palmer, on the occasion of Nightingale’s death in 1910. Here’s an excerpt, or read the original piece in our archives (free until next week on AJN‘s Web site).

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Telling Patients About Staffing Levels: Transparency or Self-Interest?

May 9, 2013

ethicsscreenshotIt’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?

The situation above is an ethical conundrum because values are in conflict. On one hand, transparency is good and patients have a right to know about administrative factors affecting their care. On the other hand, care should stay focused on a patient’s problems, not the nurse’s.

As the article excerpt above suggests, nurse staffing is a contentious issue having to do with both patient safety and job satisfaction for nurses. We’ve covered this issue many times in the past, most recently in a blog post that got quite a few comments back in January.

But should a nurse ever tell a patient about inadequate staffing? This is the ethical quandary posed by nurse ethicist Doug Olsen in his latest article, in the May issue of AJN (free until the first week of June). Having posed the situation described above, he goes on to pinpoint the ethical principles that come into play when making such a decision, explore the pros and cons of disclosing certain information to patients in various related situations, and emphasize both the need for awareness of the patient’s perspective and the necessity for nurses of engaging in honest self-examination.

As with many such situations, there’s not always a right answer; every situation is different, and gray areas do exist. What’s your take?—Jacob Molyneux, senior editor

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Nurse ‘Edge Runners’ from the AJN Archives

May 7, 2013

By Shawn Kennedy, AJN editor-in-chief

In her message to nurses for Nurses Week, ANA president Karen Daley notes, “This year’s National Nurses Week theme, ‘Delivering Quality and Innovation in Patient Care,’ emphasizes our role and influence in making the health care system work better for patients. Think about the many ways you innovate and improve care.”

The Frontier Nursing Service evolved from the Kentucky Committee for Mothers and Babies initiated by Mary Breckenridge in 1925.

The Frontier Nursing Service evolved from the Kentucky Committee for Mothers and Babies initiated by Mary Breckenridge in 1925.

We’ve been publishing our series on “Edge Runners”—those nurses designated by the American Academy of Nursing (AAN) as creative, out-of-the box innovators. In January, we profiled Marilyn Rantz for her innovative program to assist seniors to age in place; in March, we highlighted Deborah Gross for her Chicago Parent Program; for May, we have a profile of Donna Torrisi, founder of a nurse-managed family health center in Philadelpia. (The AJN articles linked to in this post will be free for the next week, until May 13, in honor of Nurses Week.)

But of course, there were ‘edge runners’ well before the AAN starting naming them. Nurses have a time-worn tradition of using their creativity and problem solving to provide care to those who need it, and AJN has chronicled many of these movers and shakers over the years.

Here’s a couple of my favorites from AJN’s archives (click through to the pdf versions to see the entire articles):

  • Lillian Wald writing about the beginning of the Henry Street Settlement in May 1902.
  • A profile of Mary Breckenridge, founder of the Frontier Nursing Service, from 1930.

We’ll bring you a few more later in the week.

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In Celebration of Nurses: Voices from AJN Archives

May 6, 2013

Today starts Nurses Week. AJN is participating in Lippincott’s Nurses Week initiative, and the entire May issue will be set for open access this week. Additionally, we are reprinting here a wonderful editorial from one of AJN’s former editors, Mary Mallison (click the text below for a larger version, or go to this link for the PDF version, free until June 6). Check in each day as we post voices from nurses from the AJN archives. Enjoy and take pride in our profession, in all that nurses have accomplished, and what nurses are doing today.—Shawn Kennedy, AJN editor-in-chief

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The Nuts and Bolts of Fluid Therapy in Critically Ill Patients

May 1, 2013

By Maureen Shawn Kennedy, AJN editor-in-chief

Back in the day when I was a bedside nurse, hemodynamic monitoring was just coming into play, and then only in coronary care. In the ER, we relied on a combination of vital signs (pulse and BP), urine output, and central venous pressure (CVP) to guide fluid administration. Later, patients in need of close monitoring received arterial lines to monitor pulmonary arterial pressures; monitors and stopcocks were everywhere (and soon after, infections, but that’s another story . . . ).

But things are changing again, and the trend is toward less-invasive monitoring. In our May issue, we’re pleased to bring you a comprehensive CE article (worth 2.6 contact hours), “Using Functional Hemodynamic Indicators to Guide Fluid Therapy.” The author is Elizabeth Bridges, PhD, RN, CCNS, an associate professor in biobehavioral nursing and health systems at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center in Seattle. Many critical care nurses will know her from her “standing room only” research sessions at the American Association of Critical Care Nurses National Teaching Institute (this year it will be in Boston, May 20–23), in my view one of the best annual national nursing meetings.

Here’s the article abstract:

Hemodynamic monitoring has traditionally relied on such static pressure measurements as pulmonary artery occlusion pressure and central venous pressure to guide fluid therapy. Over the past 15 years, however, there’s been a shift toward less invasive or noninvasive monitoring methods, which use “functional” hemodynamic indicators that reflect ventilator-induced changes in preload and thereby more accurately predict fluid responsiveness. The author reviews the physiologic principles underlying functional hemodynamic indicators, describes how the indicators are calculated, and discusses when and how to use them to guide fluid resuscitation in critically ill patients.


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Friday Nursing Blogs Roundup, More or Less

April 19, 2013

By Jacob Molyneux, AJN senior editor/blog editor

BostonAnother Friday in New York, and it’s time to do a quick tour of the nursing blogosphere after a grueling week in which the city I will always think of as home, Boston, took a major hit on a holiday that always marks the end of a long winter, the first stirrings of spring, the Red Sox playing in the morning, no one at work, glimpses of marathoners passing in the distance up still salt-stained avenues under barely budding trees, usually in bright sun and a gusty breeze with an underside of chill.

I have noted ad nauseam in the past that blogs have life cycles, wax and wane, flourish or fade out. And that’s okay. Though maybe blogs should go to a blog graveyard at some point, or be given a proper burial, or demolished like old buildings in a great controlled cinematic whoosh of collapsing pixels and pixel-dust. Or, in some cases, put in a museum to mark a moment in Web history or preserve particularly lively voices and experiences for posterity.

Enough throat clearing. There isn’t much out there to report this week. We try to collect links to sane, more or less active blogs on our nursing blogs page. A few nurse bloggers are perennially engaging and active, and a couple of these excellent bloggers even write occasional posts for this blog, so for once I won’t draw attention to them. But here’s what else I could find:

We the people. Many nurse blogs and Twitter streams and Facebook pages have been posting links to a petition to the White House to remove barriers preventing advanced practice nurses from practicing to their full scope. The petition has until just April 22 to reach the required 100,000 signatures; the last time I checked, admittedly about a week ago, it was only about a quarter of the way there. If you happen to know Justin Bieber, please ask him to publicize this. In lieu of that, consider sending it to your social media connections, and take a moment to sign yourself.

A brief note on the readability of blogs. By “readability,” I’m not talking about style, as you’d expect, but more about how easy and pleasant the blog is to read in an actual physical sense. The right word might instead be “legibility.” Or, put another way, did you choose a green or black or red background for your text? Though it’s nice to be reminded of the early days of the Web and the idiosyncratic appearance of many blogs, I now find blogs with such colored backgrounds almost impossible to read. Consider making a change to something closer to the traditional black text on a whitish background. And consider avoiding flowery fonts.

More on nurse staffing and why it matters: at the INQRI (Interdisciplinary Nursing Quality Research Initiative) blog, further confirmation that “better nurse staffing, education and work environment contribute to patient outcomes”:

A new study in Medical Care, conducted by Matthew McHugh, an RWJF Nurse Faculty Scholar,
finds that the lower mortality rates at Magnet Hospitals are achieved
in part because of investments in nursing. This study reflects many of
the findings of INQRI studies into the impact of nurse staffing, work environment and education on quality of patient care.

Conference tips. At In the Round, the blog at Nursing Center, a short post lists “tips and time-savers” for those of you who from time to time attend professional conferences. I used to go to a lot of them, and they really do take practice and some strategy.

Already sick of Nurses Week and Nurses Day (and still wondering about whether to use an apostrophe s or just an apostrophe or nothing with them)? At Impacted Nurse, there’s a strangely heartwarming yet appropriately skeptical piece called “Note to Nurse Day: I don’t need to write some silly note.”

And that’s really it for today. Have a great weekend, and let us know if you find a really good nursing blog we don’t know about yet.
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It Bears Repeating: ‘A Smart Doctor Listens to the Nurses’

April 1, 2013

AprilReflectionsIllustraionBy Jacob Molyneux, AJN senior editor

The April Reflections essay in AJN—Reflections is a monthly one-page column we’ve run for many years inside the back cover—has an unambiguous title: “A Smart Doctor Listens to the Nurses.”

Written by a pediatrician whose mother was a nurse, it gives a vision of continuity in the health care profession rather than opposition, of mothers and daughters, and seems particularly relevant as debates continue about whether or not nurses should be allowed to practice to the full scope of their abilities and knowledge. Here’s the opening paragraph, but it’s free, and we hope you’ll read the entire short essay:

I was in the hall outside a patient’s room with a new crop of interns and residents. As usual, they had all made rounds first thing in the morning, checked on new lab results, examined their patients, and were now ready to report everything to me, the attending. And, as usual, these bright, eager residents, though anxious to do a good job, hadn’t thought to talk with the nurses taking care of their patients.

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Making It Safe: Skills to Promote Healthy Conversation at Work

March 27, 2013
Photo from otisarchives4, via Flickr.

Photo from otisarchives4, via Flickr.

Medora McGinnis, RN, has written several previous posts for this blog. She is now a pediatric RN at St. Mary’s Hospital in the Bon Secours Health System, Richmond, Virginia, as well as a freelance writer.

What makes communication at work feel safe? We can all identify situations that “go south”—we feel instantly uncomfortable in the work environment (or anywhere, really) if we are accused, blamed, insulted, or overlooked. It’s easy to recognize when our communication is not safe, not going well, and not professional. So what makes it safe?

Effective communication can only take place when all parties feel safe; we must feel comfortable sharing our clinical insights without fear of the reaction we might get from the other party. While we can’t always know what their reaction will be, by learning to make it safe we can learn to talk with anyone about anything. New nurses in my hospital go through a six-month “RN residency” program in which we meet once a month for education, journaling exercises, and sharing. The book Crucial Conversations: Tips for Talking When Stakes Are High was used in our training to help us further develop our communication skills in the workplace. As a first-year nurse myself, I’ve found that some of the book’s ideas have played a big role in my learning curve.

Mistake #1: Watering down the content so the message doesn’t get across.

When things go wrong in a difficult conversation, we assume it’s the content of our conversation. In reality, it’s possible that we were so cautious with our phrasing that we didn’t get our point across at all. Honesty and openness help get the message across.

Strategy: When you reach a difficult spot, step out of the content and “build safety.” How are people responding? Are they hearing the words, or are they just becoming defensive? First, always apologize when appropriate. We can then take a moment to further that sense of safety by recognizing a shared purpose or mutual respect. For example, the nurse and the patient’s mother both want the patient to be safe; the physician and the nurse both want patient safety and comfort.

Mistake #2: Giving in—or “digging in”—when our purposes seem at odds.

Both of these are wrong responses to conflict. Do we give in when we are at odds with someone in the workplace? Or is the instinct to “dig in” and fight for your purpose, without necessarily listening to the other person?

Strategy: This is the perfect time to take a moment and build that sense of safety with the other person. Let’s recognize that we both want what’s best for the patient. “I understand that you are feeling frustrated” is a phrase that works wonders. Follow it with the recognition of the shared purpose and the steps to a resolution. A key here is to notice when safety is at risk: signs of silence, or signs of violence. Is the other party turning inward and becoming silent? Or are there physical signs that the other party is feeling trapped? Recognize these signs and focus on building safety.

Mistake #3: A lack of mutual respect.

If we aren’t showing respect toward each other, we end up trying to score points in the conversation. What makes you feel disrespected in a conversation? For me, this includes being talked over, interrupted, or even insulted. Sometimes it could just be a tone or an implication. So how do we create mutual respect in a conversation?

Strategy: First, explain what we intend to get across. “I think you do your job as our unit secretary very well, and I thank you for your hard work. However, as secretary, your job description doesn’t allow you to take a patient’s vitals.” This is clear and concise, and has a positive tone. We want to avoid explaining what we don’t intend to communicate. An example of this might be a statement like this: “I don’t want you to think that I’m saying we don’t appreciate you.” Doesn’t this leave a bad taste in your mouth? Focus on the positive.

In a healthy conversation, all parties must feel safe—safe to express their thoughts without fear of being attacked or belittled. We are each responsible for establishing this safety, and this can be done through establishing that mutual purpose and mutual respect.

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The Real Reason Why Older Nurses Don’t Retire

March 25, 2013
By Julianna Paradisi. All rights reserved.

Snow Tops/ by Julianna Paradisi

Julianna Paradisi, who blogs at JParadisi RN and elsewhere, works as an infusion nurse in outpatient oncology. Her artwork has appeared several times in AJN, and her essay, “The Wisdom of Nursery Rhymes,” was published in the February 2011 issue.

I hate to break this news to new graduate nurses struggling to find jobs, but the real reason that older nurses don’t retire isn’t—as you may have been led to believe—the struggling economy. The reason is that a large percentage of retirement-aged nurses enjoy working. As a middle-generation nurse, I’m coming to grips with this reality myself.

Many of my longtime colleagues are old enough to retire. When they do, they often retain on-call status. They never really go away. It’s weird to attend a retirement party for a coworker and then see her or him again the next day at work, helping out with a special project for their manager.

This trend among older nurses was also in evidence at a meeting I recently attended. Most of those present were nurse managers. Although a few were younger than me, most were older, sporting hipster eyeglass frames and sophisticated bob haircuts that left their natural silver.

These men and women are a testament to the profession’s development of strong, consistent leadership. Seated around the table, they suggested to me an image of Oregon’s snow-topped Cascade mountain range. And like a majestic mountain range, they represent a barrier for younger nurses desiring to take their places around that table.

Older nurses are not abandoning high acuity specialty units either. Age, once a factor in the decision to transfer into lower acuity units, is now offset by technologies that make staying easier. For example, monitors that record ICU patients’ vital signs directly into the electronic medical record save steps and energy. Smart pumps now calculate complex infusion drip rates. Hoyer lifts reduce back and muscle strain, previously a destroyer of many a nurse’s career longevity. If reimplemented, eight-hour shifts will further lengthen these careers. Also, Baby Boomers take better care of their health and receive better health care than past generations. These circumstances make it easier than ever before to delay retirement.

While younger nurses laugh at their older coworkers’ use of Zoolander-sized flip phones for text messaging (remember when we expected that cell phones would get smaller?), these older colleagues have been busy completing online master’s degrees during lunch breaks or at home while their families watch Downton Abbey. They take evening courses; earn doctorates of nursing, NP licensure, and FAAN status. Through networking, they move into leadership positions created especially by and for nurses: managers, navigators, discharge planners, and house supervisors. They’ve worked hard for these career accomplishments, and despite their advancing age, retirement is not yet a concern.

I’m not the only person observing this trend of older nurses staying in the workforce. According to this article, the vice president/CNO of Holy Family Memorial Hospital in Wisconsin reported in 2011 that the average age of the nursing staff at her hospital was 47, saying the following:

“A big piece is economic. But a lot of them love what they do. . . They’re saying ‘I don’t want to give everything up. I would just like not such a hectic pace, maybe work four-hour shifts. Maybe do education for patients or staff, different types of roles.’”

I used to joke about the nursing shortage forecasts, saying, “As long as I have a pulse and a stethoscope, I’ll have a job.” With the advances in nursing over the last two decades, perhaps this is more prophecy than jest.

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