About Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)

Editor-in-chief, (emerita), AJN

COVID-19: On and On

A note from AJN’s editor-in-chief Shawn Kennedy.

Published: March 30. As I write this, the United States has over 140,000 COVID-19 cases and over 2,400 deaths, and we’re told those numbers have yet to peak. The US Navy hospital ship Comfort is on it’s way to New York City, bringing its 1,000 beds to be used as a supplemental hospital. Its sister ship Mercy is on its way to Los Angeles. Bedside nurses and CNOs alike talk about the “war zone” that their hospitals have become. And they’re exhausted: many ICU nurses are working five days of 12-hour shifts as they await help from nurses who are getting crash courses in ventilator management.

Perspectives for and by nurses, from many angles.

Our goals during this pandemic are to serve as a reliable and up-to-date source of information and advocacy for those on the front line, to bear witness and give nurses and other health workers a voice during these uncertain times.

We’ve been using this blog to bring you evidence-based information about the COVID-19 pandemic, mostly via posts by our clinical editor Betsy Todd, whose expertise is in public health and infectious disease. She has done a yeoman’s job, researching the latest information and ensuring what we publish on PPE and COVID-19 is in in accord with the most current state of knowledge at the time—even contacting study researchers to […]

2020-03-30T15:03:14-04:00March 30th, 2020|healthcare social media, infectious diseases, Nursing, nursing perspective, Public health|0 Comments
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Defining Death

My first encounter with brain death was back in the early 1970s. I was a new RN in a shock-trauma unit. We admitted a 17-year-old young woman who had attempted suicide by jumping out of a fifth-floor window. If it wasn’t awful enough, I remember it was Thanksgiving weekend and she had been home from college.

Angiograms of normal blood flow in an active brain (at left) and lack of blood flow indicating
brain death. Photos © Fusionspark Media Inc.

As one might imagine, she sustained massive injuries, including severe head trauma. She had been intubated at the scene and was on a mechanical ventilator. Her pupils were fixed and dilated, and she had no spontaneous respirations and virtually no brain activity, according to electroencephalography (EEG) studies.

A gradual refinement of criteria.

I recall that there had to be three consecutive EEGs done before we could remove the ventilator. There was no ethics committee or formal meetings with hospital attorneys or administrators—just the physician, the family, and the pastor. And then the patient’s siblings and grandparents came to say goodbye. It was heart-wrenching.

Things have […]

2020-03-05T08:21:37-05:00March 5th, 2020|Nursing|0 Comments
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Can We Ever Overcome Burnout in Nursing?

Reality shock redux.

Flickr / Harshit Sekhon

It seems to me that we’ve been talking about burnout about as long as I’ve been in nursing, and that’s over 40 years. In 1974, Marlene Kramer’s book Reality Shock: Why Nurses Leave Nursing reported on how nurses’ dissatisfaction with their inability to practice as they were taught was a major factor in their leaving the profession. (Here’s AJN’s 1975 review of the book.) In the 1980s, it was the downsizing of staff that caused many to leave (see the February editorial for my own experience). In the last decade, as health system changes and staffing (again) engendered moral distress and burnout among members, nursing organizations sought ways to mitigate distress among nurses.

Burnout’s persistence as an issue.

But the issue persists and arguably has gotten worse, with increasingly alarming reports of high levels of burnout—between 34% and 54% physicians and nurses report symptoms—and suicides.

To address the problem, the National Academies of Science, Engineering, and Medicine (NAM) established a 17-member committee […]

2020-02-18T11:56:44-05:00February 18th, 2020|Nursing|1 Comment
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Why the Recruitment Experience of Foreign-Educated Nurses Matters for Us All

There’s been talk of a coming nursing shortage for a number of years. A recent report from the US Department of Health and Human Services National Center for Health Workforce Analysis found that of the 3.9 million RNs, the average age is 50, meaning many will retire in the next decade as they reach 65. And this is coming at the same time the number of Americans over 85 years of age is expected to double, from 6.3 million in 2015 to 13 million by 2035.

These data indicate that there may be fewer nurses, particularly in some regions of the country and in some areas of care, at a time when the need for nursing care is increasing. As with other nursing shortages, when schools are unable to graduate enough nurses to fill the gap (the shortage of qualified faculty continues to force schools to turn away qualified students), some hospitals will turn to recruiting foreign-educated nurses (FEN), many of whom are experienced and and have at least a bachelor’s degree in nursing. […]

2020-02-12T11:02:50-05:00February 12th, 2020|Nursing, nursing research|1 Comment
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Hypertonic vs. Hypotonic, Osmolality, and Other Fun Nursing Concepts

We hang fluids with varying concentrations of electrolytes in response to specific lab results, but how much do we actually remember what is going to happen physiologically?

Revisiting the fundamentals of fluid and electrolyte balance.

I remember first learning about fluids and electrolytes in undergraduate physiology, and then again all throughout medical-surgical nursing courses. When I was in orientation for my first position as an ED nurse, it was included in the critical care course. Sounds like that should have been enough—but it wasn’t.

Understanding the underlying science matters.

The basic concepts underlying the body’s mechanisms for keeping systems functioning are complex processes involving the ebb and flow of fluid and molecules controlled by several systems. It’s a delicate balance and one that we all learn in basic nursing education, but then usually recall little of it when we practice.

We hang fluids with varying concentrations of electrolytes in response to specific lab results, but how much do we actually remember what is going to happen physiologically? We know the protocol of what to infuse when, but we’re hard-pressed to explain the science underlying our practice. This is a concern because nurses are usually the first ones to review laboratory results and need to understand the implications of abnormal results and what might be […]

2020-01-21T12:02:37-05:00January 21st, 2020|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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