March Issue: Oral Intake During Labor, Malnutrition in Older Adults, RN-Performed Lumbar Puncture, More

The March issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: Original Research: An Investigation into the Safety of Oral Intake During Labor

In this study, the authors compared the maternal and neonatal outcomes among laboring women permitted ad lib oral intake with those permitted nothing by mouth except for ice chips. The findings support relaxing the restrictions on oral intake in cases of uncomplicated labor.

CE: Malnutrition in Older Adults

A review of the many cognitive, psychological, social, and economic factors that can affect the nutritional status of older adults, and how nurses can intervene to prevent and address malnutrition in these patients.

Cultivating Quality: Expanding RN Scope of Practice to Include Lumbar Puncture

A quality improvement initiative enhanced access to neurology services in an ambulatory clinic by teaching nurses to perform lumbar puncture.

Supporting Family Caregivers: No Longer Home Alone: Teaching Wound Care to Family Caregivers

Methods to promote wound healing that nurses can use to teach family caregivers, including a tear sheet of key points and links to instructional videos. This article is one in a series published in collaboration with the AARP Public Policy Institute.

2018-02-23T09:00:42+00:00 February 23rd, 2018|Nursing|0 Comments

Nursing Assistants in Nursing Homes: Partners in Quality Improvement

“NAs know where the quality gaps lie.”

I loved working in a skilled nursing facility—the long-term relationships with residents and their families, the chance to really hone in on nursing basics, the opportunity to learn about life from people who had seen it all.

But what finally drove me away from this work was the mediocre quality of care in two different “homes” where I was on staff. I was angry and frustrated, and even after several years in nursing, still too inexperienced to understand what I could have done to make things better.

Including nursing assistants in QI projects: ‘crucial to success.’

Today, care is slowly changing. Nursing homes are now required to post on the web certain data about their patient outcomes (, and to implement quality improvement (QI) initiatives. But have we regarded QI projects as the province of RNs and administrators only? In this month’s AJN, Kathleen Abrahamson and colleagues make the following observation:

“…nearly all changes driven by QI in work processes, schedules, approaches to care, or documentation will either affect or be carried out by nursing assistants. Thus, including NAs in QI efforts is crucial to their success.”

The truth of this statement is so clear, it might be called a “no-brainer.” As the authors point out, NAs have the most frequent […]

Avoiding the Chaos of Unit Transfers

Photo by Photographer’s Mate 2nd Class Johansen Laurel, U.S. Navy.

Patient transfers between units can be less than orderly, resulting in miscommunication and frustration. Most ICU nurses have a war story (or two) that quickly comes to mind if asked about a memorable admission to their unit from the OR or recovery unit. I recall one instance, when I was a clinical nurse specialist covering critical care, in which I received a frantic call at 11:30 am from the ICU nurse manager.

Apparently, the ICU had been told they would receive a patient from recovery at about 2 pm. With this in mind, the ICU had arranged to transfer a patient out to a med-surg unit just after noon. The ICU manager had worked out the transfer time with the med-surg nurse manager to allow the med-surg RN to return from lunch before the transfer, and also to give the ICU nurse a chance to have lunch and prepare the equipment in the ICU slot for the new patient after it was cleaned by housekeeping.

But as it happened, the recovery nurse manager called the ICU at 11:30 am to say her unit needed the bed and the new patient would be transferred to the ICU in 15 minutes instead of […]

Will Millennials Stave Off a Threatened Nursing Shortage? Hard to Say

Photo © Cultura Creative (RF) / Alamy Stock Photo.

The aging of the baby boom generation means that a large proportion of the U.S. population will soon be living with health conditions that may require complex care. At the same time, it’s estimated that a million nurses will retire by 2030, resulting in an enormous loss of experience and knowledge, not to mention the possibility of a national nursing shortage.

Millennials to the rescue? It’s complicated.

Can millennial nurses help mitigate the effects of this workforce shift? As discussed in our February AJN Reports, “Nurses Pass the Baton: Exit Baby Boomers, Enter Millennials,” millennials (born between 1982 and 2000) are becoming nurses in larger numbers than any generation before them. In fact, the nursing workforce is expected to grow by 36% between 2015 and 2030.

Why this surge of millennials? Commentators have speculated that those who reached adulthood during the recent recession may be drawn to the relative job security of the nursing profession, or that this generation is looking for more deeply engaging work.

2018-02-16T08:42:08+00:00 February 16th, 2018|career, Nursing, nursing career|0 Comments

Wabi-Sabi: Nursing and the Art of Brokenness

Wabi-Sabi (Kintsugi), watercolor and acrylic on paper, 2018 by Julianna Paradisi

Nursing is the art of healing, which ironically also makes it an art of brokenness. We pack and bind wounds. We administer medications to cure disease. We offer interventions for the side effects caused by the medication administered to cure.

We work in a health care system which, despite our best intentions, is broken: not enough resources, not enough staff or providers, not enough health care to go around for everyone.

Nurses have broken areas within ourselves too, but our work environments expect us to perform as perfectly as possible, amidst the brokenness of our patients, the brokenness of health care.

Patients, physicians, other departments, and hospital administrators expect nurses will fix problems, whatever they are, despite the brokenness.

A timely example this flu season is the paradoxical message: “Don’t come to work sick,” coupled with the implication, “Your sick call leaves us understaffed.”

The answer to brokenness is wholeheartedness.

The effort to fix the brokenness or imperfection of nursing and health care may be particularly exhausting for nurses because we are directly responsible for the safety of our patients.

The words of author David Whyte as he recounts a wise friend’s advice elegantly express one possible response to the existential conundrum we find at the […]